Clinical Experience in Patients with Ocular Burns Treated with Boston Type I Keratoprosthesis Implantation with or Without Prophylactic Ahmed Glaucoma Valve Implantation.

ABSTRACT

INTRODUCTION: To compare outcomes in eyes with ocular burns following Boston Type I keratoprosthesis (KPro) implantation with and without prophylactic pars plana tube surgery. METHODS: A retrospective review of patients with ocular burns who underwent KPro surgery at Zhongshan Ophthalmic Center was performed. Twenty-six eyes of 26 patients without a preoperative diagnosis of glaucoma before KPro surgery met the inclusion criteria. Preoperative glaucoma was defined as a history of a durable elevated intraocular pressure (IOP) ≥ 25 mmHg at different time points, which resulted in the introduction of anti-glaucoma medication or surgical intervention. Sixteen eyes underwent KPro alone (Group 1), and 10 eyes received KPro with prophylactic pars plana tube surgery (Group 2). RESULTS: Group 1 and Group 2 were similar in the proportions of the ocular burn type and preoperative clock hours of peripheral anterior synechiae by ultrasound biomicroscopy (1.88 ± 1.63 vs. 2.30 ± 1.83; P = 0.54). Before KPro surgery, 62.5% of eyes in Group 1 and 50.0% of eyes in Group 2 had intraocular surgeries (P = 0.53). The follow-up time was 18 months. At the final follow-up time, the two groups had similar visual acuity (1.34 ± 0.87 logMAR, 1.03 ± 0.71 logMAR; P = 0.35) and eyes with a C/D ratio ≥ 0.8 (7/16, 2/10; P = 0.21), but more eyes in Group 1 developed glaucoma de novo than eyes in Group 2 (62.5%, 20%; P = 0.04) and had undergone secondary glaucoma surgery after KPro implantation (7/16 vs. 0/10; P = 0.02). CONCLUSION: In eyes injured with ocular burns, KPro implantation with prophylactic pars plana tube surgery may be a feasible option to rehabilitate visual acuity and decrease the incidence of glaucoma de novo.