Glaucoma management in patients with penetrating keratoplasty or keratoprosthesis

Abstract

Purpose of reviewAdvances in surgical techniques and postoperative care have significantly improved rates of short-term complications following keratoplasty; however, glaucoma remains a highly prevalent long-term and potentially devastating complication for postkeratoplasty patients. In this review, we provide an overview of recent literature on glaucoma management in patients who have undergone penetrating keratoplasty or the Boston keratoprosthesis type I (KPro) implantation.Recent findingsNew research suggests an inflammatory cause underlying glaucoma following KPro. Accurate IOP measurement is difficult in patients postkeratoplasty; study of objective techniques such as PDCT or Tono-Pen in penetrating keratoplasty eyes and trans-palpebral Diaton tonometry in KPro eyes have shown promising results. Early glaucoma surgical intervention should be considered for patients undergoing penetrating keratoplasty and KPro.SummaryPatients who have undergone penetrating keratoplasty or implantation of the Boston keratoprosthesis type I should be monitored frequently for elevated intraocular pressure and for other signs of glaucomatous optic nerve damage. Intraocular pressure elevation should be treated promptly either medically or surgically while minimizing risk to the corneal graft. Further research into inflammatory causes and other treatment modalities is promising for the long-term visual success in these patients.

Advancements in Wearable and Implantable Intraocular Pressure Biosensors for Ophthalmology: A Comprehensive Review

“…Keratoprostheses (KPro) surgery is an effective milestone in treating corneal blindness [104]. However, while improvements in the surgical technique have minimized most short-term complications, unfortunately, glaucoma continues to persist as a significant and potentially severe issue for individuals who have undergone keratoplasty [105]. Adding to the complexity of IOP management for post keratoplasty patients is that it is not feasible to monitor IOP by GAT or other rebound tonometry due to the rigid B-KPro implant [106].…”