Evaluation and management of glaucoma after keratoprosthesis

To review the causes and treatment of glaucoma in Boston keratoprosthesis (K-pro) recipients.

Glaucoma exists in up to three-quarters of patients who undergo K-pro surgery. After K-pro placement, intraocular pressure (IOP) is measured by digital palpation, which has been found to be reliable in trained observers. The onset or progression of glaucoma in K-pro patients should be monitored through visual field testing, direct visualization and structural imaging of the optic nerve. Although medical therapy is an option, one-half to three-quarters of K-pro recipients are surgically managed with a glaucoma drainage device (GDD) or, less commonly, cyclophotocoagulation.

Glaucoma is a common and permanent blinding sequelae of K-pro surgery. In K-pro patients, elevated IOP and changes in the optic nerve head should result in a high index of suspicion for glaucoma. Management is frequently surgical and typically entails placement of a GDD.