Challenges in the implantation of a Boston type 1 keratoprosthesis and a glaucoma drainage device in a nanophthalmic eye.

A 67-year-old man presented with hand motions vision, a decompensated vascularised cornea and a flat anterior chamber in the right eye 5 years following cataract and glaucoma surgery. He lost the left eye several years ago following a similar intervention. The intraocular pressure (IOP) was 19 mm Hg on four antiglaucoma medications and the axial length was 19 mm. In view of the high risk for graft failure, a Boston type 1 keratoprosthesis (Kpro) was planned for visual rehabilitation, and a glaucoma drainage device (GDD) for IOP control. Although a combined GDD with Kpro was indicated, we performed sequential surgeries to avoid vision threatening hypotony-related complications. He underwent parsplana vitrectomy, prophylactic lamellar sclerectomies and Kpro at the first stage, followed by a paediatric Ahmed glaucoma valve implantation 3 months later. Despite precautions, postoperative uveal effusion occurred but could be managed conservatively. His IOP was controlled; visual acuity improved to 20/50 and remained stable at 2 years.