Angle Anatomy and Glaucoma in Patients With Boston Keratopro
The Boston type 1 keratoprosthesis is currently the most implanted keratoprosthesis in the world, This device has a collar button configuration with a polymethylmethacrylate (PMMA) front plate, a titanium or PMMA meniscus shaped backplate, and a donor cornea assembled between the
plates. It is particularly indicated for patients with severe
corneal disease highly prone to graft rejection. To quantitatively analyze the angle anatomy in eyes with a Boston type 1 keratoprosthesis (KPro) using anterior segment optical coherence tomography (AS-OCT) and to assess the diagnostic ability of AS-OCT in KPro-associated glaucoma a study was conducted.

AS-OCT (RTVue) images from KPro eyes with and
without glaucoma were reviewed. The angle opening distance at 500 mm from the scleral spur, trabecular–iris angle at 500 mm from the scleral spur, and trabecular–iris surface area at 500 mm from the scleral spur was measured by 2 observers masked to the diagnosis. The measurements for each visible quadrant were compared between KPro eyes with and without glaucoma.

22 eyes with glaucoma and 17 eyes without glaucoma from 39 patients with KPro were included. Of the 4 quadrants imaged, the temporal angle was the most visible and angle measurements of the temporal quadrant were the only ones
that differentiated the 2 groups: the mean were significantly lower in KPro eyes with glaucoma than without glaucoma. The highest area under the receiver operating characteristic curve for detecting glaucoma was 0.75 for temporal TIA500 with 50% specificity at 80% of sensitivity and a cutoff value of 37 degrees.

The temporal angle was the most visible on AS-OCT
in eyes with a KPro. Significant narrowing of the temporal angle detected on AS-OCT was associated with glaucoma in these eyes. In summary, AS-OCT may be an adjunct for the
identification and monitoring of glaucoma in patients with
KPro. The narrowing of the temporal angle, if confirmed by
future studies, may provide improved surveillance of glaucoma in this patient population and also may assist in the decision for referral to a glaucoma specialist or aggressive treatment for this important complication causing irreversible vision loss in patients with KPro.

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