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Glaucoma in Eyes With Severe Chemical Burn, Before and After Keratoprosthesis

Cade, Fabiano MD, MSc; Grosskreutz, Cynthia L MD, PhD; Tauber, Allyson; Dohlman, Claes H MD, PhD

Cornea:
doi: 10.1097/ICO.0b013e31821eead6
Clinical Science
Abstract

Purpose: The purpose of this study was to evaluate the incidence of glaucoma in eyes with severe chemical burn, before and after keratoprosthesis.

Methods: A retrospective chart review of 28 eyes of 23 patients with severe ocular chemical burns who had undergone Boston Keratoprosthesis (BKPro) surgery at the Massachusetts Eye and Ear Infirmary, between 1990 and 2010. The incidence and severity of the outcome of glaucoma, preoperatively and postoperatively, were reviewed. Related issues, such as type of chemical burn; visual acuity (VA); device retention rate; number and nature of previous, concomitant, and subsequent procedures; and incidence of other postoperative complications, were reviewed for a median follow-up time of 57 months.

Results: The number of eyes with a preoperative history or signs of glaucoma was 21, 9 of which had glaucoma progression after BKPro implantation. In addition, 2 more eyes developed glaucoma postoperatively. Preoperative vision was counting fingers or worse in all eyes. Best-corrected postoperative VA ranged from no light perception to 20/20. Seventeen eyes (61%) achieved 20/60 or better VA at some point during their follow-up, but only 9 (32%) maintained 20/60 at the last follow-up. Of the 28 eyes, 6 had the BKPro replaced once and 1 had it replaced twice. Superimposed, 8 of the most severely burned patients developed retinal detachment postoperatively.

Conclusions: Glaucoma is very common in eyes with severe chemical burns. A keratoprosthesis can rehabilitate vision, but postoperative glaucoma can be difficult to manage.

Author Information

From the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.

Received for publication November 23, 2010; revision received March 18, 2011; accepted April 10, 2011.

Supported by Keratoprosthesis Fund, Massachusetts Eye and Ear Infirmary.

Dr C. H. Dohlman is a full-time employee of Massachusetts Eye and Ear Infirmary and received no additional KPro-related income. Dr. Grosskreutz is an employee of Novartis. The remaining authors declare no conflicts of interest.

Reprints: Claes H. Dohlman, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114 (e-mail: claes_dohlman@meei.harvard.edu).

© 2011 Lippincott Williams & Wilkins, Inc.