Technique of combined glaucoma tube shunt and keratoprosthesis implantation

To describe the surgical technique and outcomes of implantation of a glaucoma drainage device (GDD) at the time of Boston type I keratoprosthesis (KPro) procedure.

Consecutive cases of combined GDD and KPro surgery performed between January 2005 and January 2011 with at least 6 months of follow-up were reviewed. Outcome measures included visual acuity, number of glaucoma medications, and complications.

Twenty-nine eyes (29 patients) underwent combined GDD and KPro surgery. 82.8% of KPro were retained at a mean follow-up of 34.4±17.7 months. Major complications included corneal necrosis (3 eyes, 10.3%), retinal detachment (3 eyes, 10.3%), endophthalmitis (1 eye, 3.4%), sterile vitritis (1 eye, 3.4%), and loss of light perception (2 eyes, 6.9%). Final corrected distance visual acuity improved in 17 (58.6%), remained unchanged in 7 (24.1%), and worsened in 5 eyes (17.2%). Mean numbers of glaucoma medications required postoperatively from 3 to 36 months were lower than the preoperative number, but the differences were not statistically significant. The tube of the GDD was able to be inserted into the anterior chamber or the ciliary sulcus in 27 eyes (91.3%). In 14 eyes with anterior segment ocular coherence tomographic evaluation, blockage of the ostium of the tube was noted in 2 eyes (14.3%).

Combined GDD and KPro surgery provides the opportunity of additional IOP management and restoring vision in the same setting, saving the patient from additional glaucoma surgery, and is not associated with an increased KPro retention failure rate or other secondary complications.