Meticulous glaucoma surveillance with structural and functional testing, combined with earlier IOP-lowering surgical intervention, may decrease glaucomatous vision loss in Boston keratoprosthesis type I (KPro) patients.1 Researchers from the Illinois Eye and Ear Infirmary, University of Illinois at Chicago, recently published such findings in the May issue of Cornea.

In the study, investigators sought to analyze glaucoma damage in KPro patients through structural analysis of the optic nerve head and digital planimetric quantification of Goldmann visual fields, a novel method of monitoring perimetric changes in KPro patients.

They reviewed the records of patients undergoing KPro implantation from 2007 to 2015 at a single institution. These included 22 eyes from 21 patients, with mean follow-up at 49.4 months. The researchers looked at pre- and post-op values for best-corrected visual acuity, number of glaucoma medications, intraocular pressure and cup-to-disc ratios. IOP-lowering procedures were performed pre-KPro in five eyes, concurrently with KPro in 10 eyes, post-KPro in six and never in another six eyes. An increase in C/D ≥0.1 and loss of V4e isopter area >30% occurred in 22.7% and 12.5%, respectively.

“Successfully obtaining optic nerve imaging and visual fields in a number of patients with implanted KPro can be challenging, and further studies focusing on developing better ways to assess IOP and glaucoma detection and progression are needed,” the researchers concluded.

1. Ali MH, Dikopf MS, Finder, AG, et al. Assessment of glaucomatous damage after Boston keratoprosthesis implantation based on digital planimetric quantification of visual fields and optic nerve head imaging. Cornea. 2018;37(5):602-08.