title: Glaucoma progression and role of glaucoma surgery in patients with Boston keratoprosthesis.
abstract: OBJECTIVE
  The aim of this study was to evaluate glaucoma onset and progression after implantation of Boston Keratoprostheses (B-KPro) and the role of glaucoma surgery.
  
  
  METHODS
  Records of patients with B-KPro implantation during 2004 to 2009 were reviewed. Parameters relevant to B-KPro surgery and glaucoma status were recorded. The data were analyzed in 5 groups based on the preoperative diagnosis.
  
  
  RESULTS
  One hundred six eyes of 87 patients were included, and the average age was 54 ± 6.7 years. Forty-six percent were female. Eighteen eyes had a B-KPro with a titanium back plate, and the others had a poly(methyl methacrylate) back plate. Thirty-three eyes were pseudophakic, and the rest were left aphakic. The follow-up time was 3.3 ± 1.0 years. Indications for implantation included past infection, congenital glaucoma, trauma, autoimmune diseases, aniridia, burns, and others. Sixty-six percent of the eyes had glaucoma preoperatively, and 26% developed de novo glaucoma afterward. The mean intraocular pressure (by finger palpation) was 16.5 ± 5.7 mm Hg. Reliable visual field tests were only available in 59% of the eyes; hence, the cup-to-disc ratio of the optic nerve head was used as the main outcome measure. In B-KPro-implanted eyes with glaucoma, 65% had undergone glaucoma surgery at some point, and 30% did not show progression. Thirty-one percent of the total cohort had disc pallor with a cup-to-disc ratio of <0.8.
  
  
  CONCLUSIONS
  Glaucoma in B-KPro remains a challenge, despite aggressive attempts to slow down its progression. Patients with glaucoma before B-KPro implantation should be considered for glaucoma surgery before or simultaneously with B-KPro implantation. The high number of eyes with disc pallor suggests that additional mechanisms other than elevated intraocular pressure may play a role in optic neuropathy.
authors: *Massachusetts Eye and Ear Infirmary Cornea Service, Harvard Medical School, Boston, MA; and †University Medical Center, Eye Clinic, Ljubljana, Slovenia.
authors: Alja
authors: A
authors: Crnej
authors: Eleftherios I
authors: EI
authors: Paschalis
authors: Borja
authors: B
authors: Salvador-Culla
authors: Allyson
authors: A
authors: Tauber
authors: Brigita
authors: B
authors: Drnovsek-Olup
authors: Lucy Q
authors: LQ
authors: Shen
authors: Claes H
authors: CH
authors: Dohlman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs; D003315:Cornea; D018450:Disease Progression; D005260:Female; D018463:Filtering Surgery; D005901:Glaucoma / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult