title: Sequential versus concomitant surgery of glaucoma drainage implant and Boston keratoprosthesis type 1.
abstract: OBJECTIVE
  To compare sequential versus concomitant surgery of glaucoma drainage implant (GDI) and Boston keratoprosthesis type 1 (KPro).
  
  
  METHODS
  Patients who received GDI and KPro in the same eye were divided into 2 groups: GDI placement prior to KPro surgery (sequential group) or GDI placement concomitant with KPro surgery (concomitant group). Main outcome measures were GDI failure, defined as intraocular pressure (IOP) &gt;21 mm Hg, less than a 20% IOP reduction from baseline, or IOP &lt;5 mm Hg on 2 consecutive follow-up visits, any reoperation for glaucoma, or loss of light perception; best-corrected visual acuity (BCVA); and surgical complications.
  
  
  RESULTS
  Thirty-five eyes were included in the study: 17 in the sequential group and 18 in the concomitant group. The cumulative incidence of failure after 5 years of follow-up was 23.5% in the sequential group and 27.8% in the concomitant group (p = 0.250). Mean BCVA was significantly better in the concomitant group after 6 months, 1 year, 2 years, and at the last follow-up (p&lt;0.05). Both groups had similar rates of complications (p = 1.000). The most frequent complication was GDI erosion, which occurred in 23.5% (n = 4/17) in the sequential group and in 27.8% (n = 5/18) in the concomitant group (p = 1.000).
  
  
  CONCLUSIONS
  Glaucoma drainage implant placement at the time of KPro surgery had similar cumulative incidence of failure, but significantly favorable visual outcomes, compared to sequential surgeries. The most frequent complication was GDI erosion, occurring in approximately one fourth of the patients.
authors.affiliation:  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Patel
authors.affiliation:  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Moster
authors.affiliation:  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Kishfy
authors.affiliation:  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Julian
authors.initials: J
authors.lastname: Barkan
authors.affiliation:  Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA - USA.
authors.forename: Tingting
authors.initials: T
authors.lastname: Zhan
authors.affiliation:  Cornea Service, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Irving M
authors.initials: IM
authors.lastname: Raber
authors.affiliation:  Cornea Service, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Ayres
authors.affiliation:  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pro
authors.affiliation:  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Waisbourd
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology