Purpose

To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation.

Design

Retrospective, comparative, nonrandomized clinical study.

Methods

Single-center study of a total of 100 eyes (100 patients) implanted with a KPro between 2008 and 2017, and diagnosed with glaucoma before or after KPro. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed de novo glaucoma after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Primary outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and nonparametric tests, as well as log-rank test to compare time-to-outcome events.

Results

Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), whereas 45 (62%) were medically managed only. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). For eyes with preexisting glaucoma, glaucoma progression was greater with glaucoma surgery performed post-KPro (100%) compared with pre-KPro (74%, P = .016) and to medical management (54%, P = .002). No increase in complications were observed with glaucoma surgery compared to medications only (P > .05), whereas fewer eyes maintained a BCVA of 20/200 or better over time with medical management (P = .013). Eyes with de novo glaucoma had similar progression, BCVA, and complications between medical and surgical care (P > .05).

Conclusions

Glaucoma surgery should be performed before or at the same time as KPro implantation in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with either preexisting or de novo glaucoma. To ensure optimal glaucoma control, glaucoma surgery should be performed as early as possible in KPro eyes with good visual potential.

中文翻译：

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评估青光眼手术在波士顿人工角膜 1 型患者中的作用和时机

目的

确定青光眼手术与波士顿人工角膜 1 型 (KPro) 植入相关的作用和最佳时机。

设计

回顾性、比较性、非随机临床研究。

方法

对 2008 年至 2017 年间总共 100 只眼睛（100 名患者）植入 KPro，并在 KPro 之前或之后诊断为青光眼的单中心研究。患者被分为 2 组：既往患有青光眼的患者和在 KPro 后发展为新发青光眼的患者。然后根据患者是接受药物治疗还是手术治疗进行分组。青光眼手术包括青光眼引流装置（GDD）植入、小梁切除术和睫状体光凝术（CPC）。主要结果包括最佳矫正视力 (BCVA)、青光眼进展和并发症。使用参数和非参数检验以及对数秩检验比较结果的差异，以比较结果事件的时间。

结果

在患有青光眼的 72 只眼中，27 只 (38%) 在 KPro (18 GDD) 之前接受了青光眼手术，而 45 只 (62%) 只接受了药物治疗。在后者中，19 人（42%）需要在 KPro 后进行青光眼手术（16 人 GDD）。在患有新发青光眼的 28 只眼中，12 只（43%）在 KPro 后接受了青光眼手术（9 GDD）。对于已有青光眼的眼睛，与 KPro 前 (74%, P  = .016) 和医疗管理 (54%, P  = .002)相比，在 KPro 后 (100%) 进行青光眼手术的青光眼进展更大。与仅药物治疗相比，青光眼手术未观察到并发症增加（P > .05），而随着时间的推移，随着时间的推移，更少的眼睛通过药物治疗维持 20/200 或更好的 BCVA（P = .013)。患有新发青光眼的眼睛在内科和外科治疗之间具有相似的进展、BCVA 和并发症 ( P > .05)。

结论

青光眼手术应在预先存在青光眼的眼睛中植入 KPro 之前或同时进行。在患有既往青光眼或新发青光眼的 KPro 眼中进行青光眼手术时，并发症发生率不会增加。为确保最佳的青光眼控制，应尽早对具有良好视觉潜力的 KPro 眼进行青光眼手术。