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Glaucoma Progression and Role of Glaucoma Surgery in Patients With Boston Keratoprosthesis

Crnej, Alja MD, FEBO*,†; Paschalis, Eleftherios I. PhD*; Salvador-Culla, Borja MD*; Tauber, Allyson*; Drnovsek-Olup, Brigita MD, PhD; Shen, Lucy Q. MD*; Dohlman, Claes H. MD, PhD*

doi: 10.1097/ICO.0000000000000067
Clinical Science

Purpose: 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.

Author Information

*Massachusetts Eye and Ear Infirmary Cornea Service, Harvard Medical School, Boston, MA; and

University Medical Center, Eye Clinic, Ljubljana, Slovenia.

Reprints: Claes H. Dohlman, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA (e-mail:

The authors have no funding or conflicts of interest to disclose.

Received October 31, 2013

Accepted December 06, 2013

© 2014 by Lippincott Williams & Wilkins.