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Sequential versus concomitant surgery of glaucoma drainage implant and Boston keratoprosthesis type 1

Abstract

Purpose

To compare sequential versus concomitant surgery of glaucoma drainage implant (GDI) and Boston keratoprosthesis type 1 (KPro).

Methods

Patients who received GDI and KPro in the same eye were divided into 2 groups: GDI placement prior to KPro surgery (sequential group) or GDI placement concomitant with KPro surgery (concomitant group). Main outcome measures were GDI failure, defined as intraocular pressure (IOP) >21 mm Hg, less than a 20% IOP reduction from baseline, or IOP <5 mm Hg on 2 consecutive follow-up visits, any reoperation for glaucoma, or loss of light perception; best-corrected visual acuity (BCVA); and surgical complications.

Results

Thirty-five eyes were included in the study: 17 in the sequential group and 18 in the concomitant group. The cumulative incidence of failure after 5 years of follow-up was 23.5% in the sequential group and 27.8% in the concomitant group (p = 0.250). Mean BCVA was significantly better in the concomitant group after 6 months, 1 year, 2 years, and at the last follow-up (p<0.05). Both groups had similar rates of complications (p = 1.000). The most frequent complication was GDI erosion, which occurred in 23.5% (n = 4/17) in the sequential group and in 27.8% (n = 5/18) in the concomitant group (p = 1.000).

Conclusions

Glaucoma drainage implant placement at the time of KPro surgery had similar cumulative incidence of failure, but significantly favorable visual outcomes, compared to sequential surgeries. The most frequent complication was GDI erosion, occurring in approximately one fourth of the patients.

Eur J Ophthalmol 2016; 26(6): 556 - 563

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/ejo.5000794

Authors

Varun Patel, Marlene R. Moster, Louis Kishfy, Julian Barkan, Tingting Zhan, Irving M. Raber, Brandon D. Ayres, Michael J. Pro, Michael Waisbourd

Article History

Disclosures

Financial support: No financial support was received for this submission.
Conflict of interest: Dr. Marlene Moster is a consultant for Alcon, Allergan, Solx, and Merck; was an expert testimony case witness in 2013; has grants from Aerie, Aeon, New World Medical, Alcon, Glaukos, and Bausch and Lomb; and receives payment for lectures from Alcon, Allergan, Ista, Merck, Bausch and Lomb, New World Medical, TBI, and Solx. Dr. Irving Raber receives payment for lecture services from Bausch and Lomb. Dr. Brandon Ayres is a consultant for Allergan and Biotissue and receives payment for lecture services from Bausch and Lomb. For the remaining authors, no conflicts of interest are declared.

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Authors

Affiliations

  •  Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA - USA
  •  Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA - USA
  •  Cornea Service, Wills Eye Hospital, Philadelphia, PA - USA

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