Glaucoma Drainage Implant Surgery Combined with Pars Plana Vitrectomy and KPro Implantation

  • Thasarat S. VajaranantEmail author
  • Ahmad A. Aref
Part of the Essentials in Ophthalmology book series (ESSENTIALS)


Glaucoma occurs with a relatively high frequency after Boston KPro (KPro) implantation. Disease course is often aggressive in nature and requires surgical intervention. Combined surgical techniques involving glaucoma drainage implant (GDI) surgery at the time of initial KPro implantation provide for successful postoperative results. The current chapter describes a technique involving combined GDI, KPro, and vitreoretinal surgeries. Posterior placement of the GDI tube allows for adequate postoperative contact lens fitting, decreasing the risk of conjunctival erosion and subsequent tube exposure. Patient candidates for this procedure must demonstrate medical and social stability as rigorous postoperative care is required to allow for proper monitoring and adjustment of medications. Coordination of care among expert ophthalmic subspecialists allows for optimal surgical outcome.


Glaucoma Surgery KPro Glaucoma implant Glaucoma shunt Glaucoma surgery Keratoprosthesis Boston keratoprosthesis Intraocular pressure 


Compliance with Ethical Requirements

Thasarat S. Vajaranant and Ahmed A. Aref declare that they have no conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. No animal studies were carried out by the authors for this article.

Supplementary material

Video 11.1

Glaucoma Drainage Implant Surgery Combined with Pars Plana Vitrectomy and KPro Implantation; Ahmad A. Aref, MD, Maria S. Cortina, MD, Felix Y. Chau, MD, Thasarat S. Vajaranant, MD, and Jose de la Cruz, MD (MPG 132,552 kb)


  1. 1.
    Netland PA, Scott ML, Boyle 4th JW, Lauderdale JD. Ocular and systemic findings in a survey of aniridia subjects. J AAPOS. 2011;15:562–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Talajic JC, Agoumi Y, Gagne S, Moussally K, Harissi-Dagher M. Prevalence, progression, and impact of glaucoma on vision after Boston type 1 KPro surgery. Am J Ophthalmol. 2012;153:267–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Panarelli JF, Ko A, Sidoti PA, Garcia JP, Banitt MR. Angle closure after Boston KPro. J Glaucoma. 2012;22:725–9.CrossRefGoogle Scholar
  4. 4.
    Kamyar R, Weizer JS, de Paula FH, Stein JD, Moroi SE, John D, Musch DC, Mian SI. Glaucoma associated with Boston type 1 KPro. Cornea. 2012;31:134–9.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Chew HF, Ayers BD, Hammersmith KM, Rapuano CJ, Laibson PR, Myers JS, Jin YP, Cohen EJ. Boston KPro outcomes and complications. Cornea. 2009;28:989–96.CrossRefPubMedGoogle Scholar
  6. 6.
    Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789–803.PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Vajaranant TS, Blair MP, McMahon T, Wilensky JT, de la Cruz J. Special considerations for pars plana tube-shunt placement in Boston type 1 keratoprosthesis. Arch Ophthalmol. 2010;128(11):1480–2.CrossRefPubMedGoogle Scholar
  8. 8.
    El Mallah MK. Surgical management for glaucoma. Trabeculectomy and glaucoma drainage devices. In: Edward DP, Vajaranant TS, editors. Glaucoma. New York: Oxford University Press; 2013. p. 181–98.Google Scholar
  9. 9.
    Baum J, Chaturvedi N, Netland PA, Dreyer EB. Assessment of intraocular pressure by palpation. Am J Ophthalmol. 1995;119:650–1.CrossRefPubMedGoogle Scholar
  10. 10.
    Kapamajian MA, de la Cruz J, Hallak JA, Vajaranant TS. Correlation between corneal and scleral pneumatonometry: an alternative method for intraocular pressure measurement. Am J Ophthalmol. 2013;156:902–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Todani A, Behlau I, Fava MA, Cade F, Cherfan DG, Zakka FR, Jakobiec FA, Gao Y, Dohlman CH, Melki SA. Intraocular pressure measurement by radio wave telemetry. Invest Ophthalmol Vis Sci. 2011;52:9573–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Rizq RN, Choi WH, Eilers D, Wright MM, Ziaie B. Intraocular pressure measurement at the choroid surface: a feasibility study with implications for implantable microsystems. Br J Ophthalmol. 2001;85:868–71.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Rivier D, Paula JS, Kim E, Dohlman CH, Grosskreutz CL. Glaucoma and KPro: role of adjunctive cyclophotocoagulation. J Glaucoma. 2009;18:321–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Huh ES, Aref AA, Vajaranant TS, de la Cruz J, Chau FY, Cortina MS. Outcomes of pars plana glaucoma drainage implant in Boston type 1 KPro surgery. J Glaucoma. 2014;23:e39–44.CrossRefPubMedGoogle Scholar
  15. 15.
    Law SK, Huang JS, Nassiri N, Moghimi S, Nilforushan N, Parham A, Moossai J, Kim M, Caprioli J, Aldave AJ. Technique of combined glaucoma tube shunt and KPro implantation. J Glaucoma. 2014;23(8):501–7 [In Press].CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Illinois Eye and Ear InfirmaryUniversity of Illinois at Chicago School of MedicineChicagoUSA

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