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Baerveldt glaucoma implant in paediatric patients
K A van Overdam1, J T H N de Faber, H G Lemij
1The Rotterdam Eye Hospital, Schiedamse Vest 180, 3011 BH Rotterdam, Netherlands.
Insights
The Baerveldt glaucoma implant (BGI) shows an 80% success rate in pediatric glaucoma patients, offering a safe treatment option when other surgeries fail. Careful management of tube-related complications is advised.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pediatric Glaucoma Management
Background:
- Pediatric glaucoma presents unique challenges in intraocular pressure (IOP) management.
- Traditional angle surgeries may be unsuitable or unsuccessful in young patients.
- The Baerveldt glaucoma implant (BGI) offers an alternative surgical approach.
Purpose of the Study:
- To evaluate the efficacy and safety of the Baerveldt glaucoma implant (BGI) in treating pediatric glaucoma.
- To assess long-term outcomes and complications associated with BGI implantation in children.
Main Methods:
- A retrospective, non-comparative case series included 55 eyes of 40 pediatric patients (≤16 years) with primary or secondary glaucoma.
- Baerveldt (350 mm2) implants were surgically placed.
- Surgical outcomes were analyzed using Kaplan-Meier survival analysis.
Main Results:
- An overall success rate of 80% was observed at the final follow-up (mean 32 months).
- Cumulative success rates remained high, reaching 94% at 12 and 24 months, but declined to 44% by 60 months.
- The most frequent postoperative complications included tube-related issues (20%) and mild to moderate dyscoria (22%) due to iris entrapment.
Conclusions:
- The Baerveldt glaucoma implant (BGI) is an effective and safe option for managing pediatric primary and secondary glaucoma.
- BGI serves as a viable treatment when angle surgery is unsuccessful or inappropriate in pediatric cases.
- Clinicians should anticipate and be prepared to manage potential tube-related complications.
Aim:
To evaluate the Baerveldt glaucoma implant (BGI) in paediatric glaucoma treatment.
Methods:
In a retrospective non-comparative case series 55 eyes of 40 consecutive paediatric patients (< or =16 years) with primary or secondary glaucoma underwent Baerveldt (350 mm2) implantation. Surgical outcome was evaluated by Kaplan-Meier table analysis.
Results:
The overall success rate was 80% at last follow up, with a mean follow up of 32 (range 2-78) months. Cumulative success was 94% at 12 months and 24 months, 85% at 36 months, 78% at 48 months, and 44% at 60 months. 11 eyes (20%) failed postoperatively because of an IOP >21 mm Hg (eight eyes), persistent hypotony (two eyes), and choroidal haemorrhage following cataract surgery (one eye). The most frequent complication needing surgery was tube related (20%). A new observation was mild to moderate dyscoria in 22% of the eyes, all buphthalmic, caused by entrapment of a tuft of peripheral iris in the tube track.
Conclusions:
The BGI is effective and safe in the management of primary and secondary glaucoma. When angle surgery has proved to be unsuccessful or inappropriate in paediatric patients, a BGI is a good treatment option. One must be prepared to deal with the tube related problems.
