Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging

Ali, Mohsin; Dikopf, Mark S.; Finder, Anthony G.; Aref, Ahmad A.; Vajaranant, Thasarat S.; Cruz, José de la; Cortina, María Soledad

doi:10.1097/ico.0000000000001544

Cited by 20 publications

(17 citation statements)

References 27 publications

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“…1 We have been confronted with the complication of glaucoma because of our interest in artificial corneas. [2][3][4] After marked improvements in postoperative management and also in design during the past 2 decades, such devices can give great vision in the short and intermediate terms, if the rest of the eye allows, but severe glaucoma can still in the long run be the most significant complication [5][6][7][8][9][10][11][12][13][14][15] (Fig. 1).…”

mentioning

confidence: 99%

Glaucoma After Corneal Trauma or Surgery—A Rapid, Inflammatory, IOP-Independent Pathway

Dohlman

Zhou

Lei

et al. 2019

Cornea

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To review clinical aspects and cellular and molecular steps in the development of long-term glaucoma after corneal surgery or acute trauma-especially the pivotal role of tumor necrosis factor alpha (TNF-a), the rapidity of the secondary damage to the retinal ganglion cells, and the clinical promise of early antiinflammatory intervention.Methods: A series of laboratory studies on post-injury and postsurgery glaucoma have been compared to clinical outcome studies on the subject, focusing particularly on the vulnerability of the retinal ganglion cells. Alkali burn to the cornea of mice and rabbits served as the main experimental model. TNF-a titer, ganglion cell apoptosis, and depletion of optic nerve axons have been examined. Anti-TNF-a antibodies or corticosteroids have been used to protect the retinal ganglion cells. Intraocular pressure (IOP) postburn was recorded by manometric methods. Results:In animals with alkali burn to the cornea, damage to the retina can occur within 24 to 72 hours. This is not because of a direct pH change posteriorly-the alkali is effectively buffered at the iris-lens level. Rather, TNF-a (and other inflammatory cytokines), generated anteriorly, rapidly diffuses posteriorly to cause apoptosis of the ganglion cells. During this time, the IOP remains much lower than the reported values required to cause ganglion cell damage. The TNF-a antibody infliximab or corticosteroids, if administered promptly, are markedly protective of the ganglion cells.

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mentioning

confidence: 99%

Glaucoma After Corneal Trauma or Surgery—A Rapid, Inflammatory, IOP-Independent Pathway

Dohlman

Zhou

Lei

et al. 2019

Cornea

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“…Glaucoma is the leading cause of permanent visual loss in BKPro. 51 Prevalence of preexisting glaucoma varied from 33.3% to 89.3% 62 Our report found that 20.2-40% of eyes had intraocular pressure (IOP) elevation, 14-36% developed de-novo glaucoma and 13-33% had glaucoma progression (Table 1). Due to preexisting corneal pathology, it is difficult to accurately evaluate IOP, optic nerve and visual fields before BKPro surgery.…”

Section: Glaucoma-associated Complicationsmentioning

confidence: 94%

“…85 In addition to better IOP monitoring, several publications advocate the use of anterior segment optical coherence tomography (OCT), 3D-optic nerve OCT, optic nerve head imaging and digital planimetric analysis of Goldman visual field, to better assess structural and functional glaucomatous change after BKPro implantation. 62,63,86 Many modalities are also postulated to prevent other BKPro-related complications. The lack of biointegration has long been considered one of the greatest BKPro downsides leading to a continuous risk of intraocular infection.…”

Section: Future Of Bkpromentioning

confidence: 99%

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

Nonpassopon¹,

Niparugs²,

Cortina³

2020

OPTH

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The use of Boston type 1 keratoprosthesis (BKPro) has significantly increased worldwide. It is no longer considered a procedure of last resort but a reasonable option for patients with otherwise poor prognosis for a traditional penetrating keratoplasty. BKPro was approved by the Food and Drug Administration in 1992 for bilateral severe corneal blindness due to multiple corneal transplant failure. Over the years, indications have extended beyond recurrent immunologic rejection to include other conditions such as chemical injury and other causes of bilateral limbal stem cell deficiency, extensive corneal neovascularization, neurotrophic corneas and hypotony, among others. Numerous advances in the design of the BKPro, improvement of preoperative, intraoperative and postoperative management have resulted in favorable outcomes and a reduction in postoperative complications. Accordingly, many studies have shown that implantation of this device is highly effective in restoring vision with very good short-term outcomes. However, due to the lifetime risk of sight-threatening complications after BKPro implantation, a longer follow-up period should provide outcomes that are more realistic. In this review, the authors examined only the results of publications with an average of at least 2 years of follow-up. The overall intermediate to long-term visual outcomes and retention rate in BKPro seem to be favorable. However, autoimmune diseases and cicatrizing conditions continue to show a higher incidence of postoperative complications that require further management.

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“…Evaluation of retinal nerve fiber layer (RNFL) at the optic nerve head with OCT is possible and could be a useful tool for monitoring glaucoma progression in KPro eyes. 26 , 27 Retinal nerve fiber layer (RNFL) thinning is the most common indicator of glaucoma progression. In fact, RNFL thinning may precede defects in the visual field.…”

Section: Introductionmentioning

confidence: 99%

“…Visual field testing can also be used in the assessment of functional glaucomatous changes in KPro eyes. 26 , 27 Normally, Goldmann visual field (GVF) test is most commonly used to delineate visual field defects in KPro eyes. A novel method used digital planimetric analysis of GVFs was proposed by Ali et al 27 This method involved using the V4e isopter beyond the central 24 degrees for all patients, and a loss of more than 30% of surface area was considered as visual field deterioration in KPro eyes.…”

Section: Introductionmentioning

confidence: 99%

Challenges of Glaucoma Management in Patients with Type I Boston Keratoprosthesis

AlHilali¹,

Al-Swailem²

2022

OPTH

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Type I Boston keratoprosthesis is implanted in patients with severely diseased eyes who are considered poor candidates for traditional keratoplasty. Glaucoma is considered a major visual comorbidity following the implantation of type I Boston keratoprosthesis (KPro). Eyes that receive a Boston KPro are at high risk of progression of pre-existing glaucoma and the development of de novo glaucoma. Both complications can limit best-corrected visual acuity postoperatively. Diagnosis and surveillance for glaucoma in KPro eyes are fundamental to mitigate the risk of visual morbidity. However, managing these patients presents several challenges. The diagnosis of glaucoma after KPro implantation is usually hindered by inaccurate intraocular pressure (IOP) measurements and unreliable ophthalmic investigations such as visual field testing and optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL). In these eyes, medical management of glaucoma with topical medications is usually insufficient, and glaucoma surgery is usually warranted either prior to or during KPro implantation. Options for glaucoma surgery include glaucoma drainage device (GDD) and cyclodestructive procedures. The aim of this article is to highlight the incidence, pathophysiology, diagnosis, and management options of glaucoma in eyes that have undergone type I Boston keratoprosthesis.

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Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging

Cited by 20 publications

References 27 publications

Glaucoma After Corneal Trauma or Surgery—A Rapid, Inflammatory, IOP-Independent Pathway

Glaucoma After Corneal Trauma or Surgery—A Rapid, Inflammatory, IOP-Independent Pathway

<p>Boston Type 1 Keratoprosthesis: Updated Perspectives</p>

Challenges of Glaucoma Management in Patients with Type I Boston Keratoprosthesis

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