Monitoring Of Glaucoma After The Implantation Of...
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Monitoring Of Glaucoma After The Implantation Of Keratoprosthesis M. Papadia 1 , R. Scotto 1 , A. Bagnis 1 , A. Macrì 2 , C.E. Traverso 1 1.Clinica Oculistica, DiNOG, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy 2. IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy Commercial Rela,onship: R Sco&o, None; M Papadia, None; A Bagnis, None; A Macrì, None; C E Traverso, None. PATIENTS AND METHOD Pa,ent 1: Female, age 80, preoperaBve corneal diagnosis was graD failure in associaBon with glaucoma, preoperaBve best corrected visual acuity (BCVA) was finger counBng (FC), postoperaBve BCVA was 20/63. This paBent received anBglaucoma treatment before and aDer Kpro surgery with Bmolol, latanoprost and oral acetazolamide. Pa,ent 2: Male, age 54, preoperaBve corneal diagnosis was bilateral chemical injury, preoperaBve BCVA was light percepBon (LP), post operaBve BCVA was 20/50, digital assessment of IOP was normal before and aDer surgery. Pa,ent 3: Male, age 42, preoperaBve corneal diagnosis was graDversushost disease, preoperaBve BCVA was light percepBon (LP), post operaBve BCVA was 20/40, digital assessment of IOP was normal before and aDer surgery. Intraocular pressure assessment was performed by palpaBon. Visual fields were performed aDer surgery by using automated perimetry with Humphrey SITA Standard programs and with Octopus Dynamic programs. OpBc nerve and ReBnal Nerve Fiber Layer evaluaBon were performed with HRT III (Heidelberg Engineering) and Rtvue OCT (Optovue, Inc). Reliability indexes of HRT, OCT and VF fixaBon losses were 28,5 μm (±7,8), 38,4 (±7,9), 1,4/17. INTRODUCTION The Boston type 1 keratoprosthesis, approved by the Food and Drug AdministraBon in 1992, was developed for paBents who are poor candidates for tradiBonal keratoplasty because of a high risk of graD failure or rejecBon. Longterm complicaBons of the Boston type 1 Kpro, including glaucoma, are well documented by the literature. The rate of extrusion and endophthalmiBs aDer KPro surgery is significantly lower since the introducBon of bandage contact lenses, prophylacBc anBbioBcs, and an improved threadless design. Despite such advances, glaucoma can compromise visual rehabilitaBon in these paBents in spite of a clear opBcal window. Figure 1: Scheme of Boston Kpro 1 Figure 2: Patient before surgery Figure 2: Patient after Boston KPro surgery CONCLUSION The Boston type 1 Keratoprosthesis is an important and viable opBon for salvaging vision aDer mulBple keratoplasty failures and in paBents with a high risk of failure with tradiBonal graDing methods. Glaucoma emerges as an important longterm complicaBon of this procedure. Monitoring of IOP is extremely difficult, is complicated by the lack of objecBve tonometry, leaving clinicians with no other means than palpaBon to evaluate IOP. Visual field examinaBon and imaging methods are paramount for glaucoma monitoring; we show the feasibility in paBents implanted with a keratoprosthesis. References Netland PA, Terada H, Dohlman CH. Glaucoma associated with keratoprosthesis. Ophthalmology. 1998 Apr;105(4):7517. Gomaa A, Comyn O, Liu C. Keratoprostheses in clinical pracBce a review. Clin Experiment Ophthalmol. 2010 Mar;38(2):21124. Greiner MA, Li JY, Mannis MJ. Longerterm vision outcomes and complicaBons with the Boston type 1 keratoprosthesis at the University of California, Davis Ophthalmology. 2011 Aug;118(8):154350. Li JY, Greiner MA, Brandt JD, Lim MC, Mannis MJ. Longterm complicaBons associated with glaucoma drainage devices and Boston keratoprosthesis. Am J Ophthalmol. 2011 Aug;152(2):20918. Talajic JC, Agoumi Y, Gagné S, Moussally K, HarissiDagher M. Prevalence, progression, and impact of glaucoma on vision aDer Boston type 1 keratoprosthesis surgery. Am J Ophthalmol. 2012 Feb;153(2):267274. Kamyar R, Weizer JS, de Paula FH, Stein JD, Moroi SE, John D, Musch DC, MianSI. Glaucoma associated with Boston type I keratoprosthesis. Cornea. 2012Feb;31(2):1349.
Transcript of Monitoring Of Glaucoma After The Implantation Of...
Monitoring Of Glaucoma After The Implantation Of Keratoprosthesis
M. Papadia1, R. Scotto1, A. Bagnis1, A. Macrì2, C.E. Traverso1 1.Clinica Oculistica, DiNOG, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino - IST,
Genoa, Italy
2. IRCCS Azienda Ospedaliera Universitaria San Martino - IST, Genoa, Italy
Commercial Rela,onship: R Sco&o, None; M Papadia, None; A Bagnis, None; A Macrì, None; C E Traverso, None.
PATIENTS AND METHOD Pa,ent 1: Female, age 80, preoperaBve corneal diagnosis was graD failure in associaBon with glaucoma, pre-‐operaBve best corrected visual acuity (BCVA) was finger counBng (FC), post-‐operaBve BCVA was 20/63. This paBent received anB-‐glaucoma treatment before and aDer Kpro surgery with Bmolol, latanoprost and oral acetazolamide. Pa,ent 2: Male, age 54, preoperaBve corneal diagnosis was bilateral chemical injury, pre-‐operaBve BCVA was light percepBon (LP), post-‐operaBve BCVA was 20/50, digital assessment of IOP was normal before and aDer surgery. Pa,ent 3: Male, age 42, preoperaBve corneal diagnosis was graD-‐versus-‐host disease, pre-‐operaBve BCVA was light percepBon (LP), post-‐operaBve BCVA was 20/40, digital assessment of IOP was normal before and aDer surgery.
Intraocular pressure assessment was performed by palpaBon. Visual fields were performed aDer surgery by using automated perimetry with Humphrey SITA Standard programs and with Octopus Dynamic programs. OpBc nerve and ReBnal Nerve Fiber Layer evaluaBon were performed with HRT III (Heidelberg Engineering) and Rtvue OCT (Optovue, Inc). Reliability indexes of HRT, OCT and VF fixaBon losses were 28,5 μm (±7,8), 38,4 (±7,9), 1,4/17.
INTRODUCTION The Boston type 1 keratoprosthesis, approved by the Food and Drug AdministraBon in 1992, was developed for paBents who are poor candidates for tradiBonal keratoplasty because of a high risk of graD failure or rejecBon. Long-‐term complicaBons of the Boston type 1 Kpro, including glaucoma, are well documented by the literature. The rate of extrusion and endophthalmiBs aDer KPro surgery is significantly lower since the introducBon of bandage contact lenses, prophylacBc anBbioBcs, and an improved threadless design. Despite such advances, glaucoma can compromise visual rehabilitaBon in these paBents in spite of a clear opBcal window.
Figure 1: Scheme of Boston Kpro 1
Figure 2: Patient before surgery
Figure 2: Patient after Boston KPro surgery
CONCLUSION The Boston type 1 Keratoprosthesis is an important and viable opBon for salvaging vision aDer mulBple keratoplasty failures and in paBents with a high risk of failure with tradiBonal graDing methods. Glaucoma emerges as an important long-‐term complicaBon of this procedure. Monitoring of IOP is extremely difficult, is complicated by the lack of objecBve tonometry, leaving clinicians with no other means than palpaBon to evaluate IOP. Visual field examinaBon and imaging methods are paramount for glaucoma monitoring; we show the feasibility in paBents implanted with a keratoprosthesis.
References -‐ Netland PA, Terada H, Dohlman CH. Glaucoma associated with keratoprosthesis. Ophthalmology. 1998 Apr;105(4):751-‐7. -‐ Gomaa A, Comyn O, Liu C. Keratoprostheses in clinical pracBce -‐ a review. Clin Experiment Ophthalmol. 2010 Mar;38(2):211-‐24. -‐ Greiner MA, Li JY, Mannis MJ. Longer-‐term vision outcomes and complicaBons with the Boston type 1 keratoprosthesis at the University of California, Davis Ophthalmology. 2011 Aug;118(8):1543-‐50. -‐ Li JY, Greiner MA, Brandt JD, Lim MC, Mannis MJ. Long-‐term complicaBons associated with glaucoma drainage devices and Boston keratoprosthesis. Am J Ophthalmol. 2011 Aug;152(2):209-‐18. -‐ Talajic JC, Agoumi Y, Gagné S, Moussally K, Harissi-‐Dagher M. Prevalence, progression, and impact of glaucoma on vision aDer Boston type 1 keratoprosthesis surgery. Am J Ophthalmol. 2012 Feb;153(2):267-‐274. -‐ Kamyar R, Weizer JS, de Paula FH, Stein JD, Moroi SE, John D, Musch DC, MianSI. Glaucoma associated with Boston type I keratoprosthesis. Cornea. 2012Feb;31(2):134-‐9.
