We read with appreciation the comments from Cortina and associates in response to our recent article on long-term complications associated with a glaucoma drainage device (GDD) in patients with Boston keratoprosthesis. We were pleased by their interest in our publication, and we acknowledge their contributions to one of the most challenging aspects of keratoprosthesis surgery.

Their technique for pars plana Ahmed valve (FP7; New World Medical, Inc, Rancho Cucamonga, California, USA) placement with a partial thickness corneoscleral patch graft is described nicely in their case series. Our series of 9 patients with GDD erosions did include 4 erosions that occurred in GDDs placed in the pars plana. The main difference in our series, however, was the use of Tutoplast allograft pericardium (Tutoplast; IOP, Inc, Costa Mesa, California, USA) to cover the tube. The suggestion that a partial thickness corneoscleral patch graft may provide a smoother surface than Tutoplast, and thus may decrease the mechanical effects that may contribute to GDD erosions in these patients, is worth exploring further. We also find that an advantage of a corneoscleral patch graft is that in the event of a recurrent erosion, the corneal material is more likely to re-epithelialize than Tutoplast. This simple modification of GDD technique easily could be adopted by glaucoma surgeons who are assisting in the management of these challenging patients.

Ultimately, this highlights once again the importance of an atmosphere of collaboration, as different centers and different ophthalmic disciplines continue to work together to restore and maintain vision for these patients.