Glaucoma Evaluation and Management in Eyes With Boston Type 1 and Aurolab Keratoprostheses in an Indian Cohort.

PURPOSE

The purpose of this study was to evaluate glaucoma and its management in eyes with Boston type 1 keratoprosthesis (Boston-Kpro) and Aurolab keratoprosthesis (Auro-Kpro) in an Indian cohort.

METHODS

This retrospective comparative case series included 175 eyes of 175 patients who underwent type 1 keratoprosthesis from 2009 until 2017; type 1 Boston-Kpro was performed in 107 eyes (107 patients) and Auro-Kpro in 68 eyes (68 patients). The eyes with <1-month follow-up were excluded, and hence, for the analysis of glaucoma, 62 eyes with Auro-Kpro and 99 eyes with Boston-Kpro were included. Progression was defined as the worsening of optic disc damage/progression by visual field/uncontrolled IOP needing additional medications or glaucoma surgery.

RESULTS

The post-Kpro mean follow-up was 1.8 ± 1.7 years. After Kpro, overall glaucoma was noted in 61% of eyes (98/161). Preexisting glaucoma was noted in 28% of eyes (45/161), postoperative glaucoma was noted in 33% of eyes (53/161), and 39% of eyes (63/161) did not have glaucoma. Among those with preexisting glaucoma, 49% of eyes (22/45) progressed after Kpro implantation. The proportion of eyes with glaucoma in Auro-Kpro (56.5% of eyes) and Boston-Kpro (63.6% of eyes) was similar (P = 0.46). The Kaplan-Meier curve for cumulative survival (Kpro-retention rate) was similar in eyes with and without glaucoma (83% vs. 76% at 1 year, 72% vs. 70% at 2 years; P = 0.65). A higher number of prior intraocular surgeries (P = 0.04) was significantly associated with risk for postoperative glaucoma.

CONCLUSIONS

Glaucoma was seen in more than half of the eyes with type 1 keratoprosthesis. The presence of glaucoma did not seem to affect the retention of keratoprosthesis. A high rate of postoperative glaucoma and the progression of preexisting glaucoma need close monitoring and appropriate management.