title: Glaucoma in modified osteo-odonto-keratoprosthesis eyes: role of additional stage 1A and Ahmed glaucoma drainage device-technique and timing.
abstract: OBJECTIVE
  To report the technique, timing, and outcomes of the Ahmed glaucoma drainage device in eyes with the modified osteo-odonto-keratoprosthesis (MOOKP) and the role of an additional stage 1A to the Rome-Vienna protocol.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Case records of 22 eyes of 20 patients with high intraocular pressure at various stages of the MOOKP procedure performed in 85 eyes of 82 patients were studied. Stage 1A, which includes total iridodialysis, intracapsular cataract extraction, and anterior vitrectomy, was done in all eyes as the primary stage.
  
  
  RESULTS
  Seventeen Ahmed glaucoma drainage devices were implanted in 15 eyes of 14 patients (chemical injury in 9 [10 eyes] and Stevens-Johnson syndrome in 5 patients). Implantation was performed during and after stage 1A in 2 and 7 eyes, respectively, after stage 1B+1C in 1 eye, and after stage 2 in 6 eyes. Eleven of 15 eyes (73.3%) remained stable with adequate control of intraocular pressure over a mean follow-up period of 33.68 months (1-90 months). Complications related to the drainage device were hypotony in 1 eye and vitreous block of the tube in 1 eye.
  
  
  CONCLUSIONS
  It is ideal to place the Ahmed glaucoma drainage device prior to the mucosal graft when the anatomy of the ocular surface is least altered with best outcomes. The technique of placement of the drainage device during the various stages of the MOOKP procedure has been described. The intraocular pressure stabilized in three quarters of the eyes with pre-existing glaucoma.
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India. Electronic address: drgeethaiyer@gmail.com.
authors.forename: Geetha
authors.initials: G
authors.lastname: Iyer
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Srinivasan
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Roshni
authors.initials: R
authors.lastname: Shetty
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Sripriya
authors.initials: S
authors.lastname: Krishnamoorthy
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Shantha
authors.initials: S
authors.lastname: Balekudaru
authors.affiliation: Medical Research Foundation, Sankara Nethralaya, Chennai, India.
authors.forename: Lingam
authors.initials: L
authors.lastname: Vijaya
mesh_terms: D000328:Adult; D000539:Alveolar Process / Q000637:transplantation*; D001705:Bioprosthesis; D003316:Corneal Diseases / Q000601:surgery*; D005260:Female; D005901:Glaucoma / Q000209:etiology* / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013997:Time Factors; D014065:Tonometry, Ocular; D014092:Tooth Root / Q000637:transplantation*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult