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Pars plana Baerveldt implantation for refractory childhood glaucomas
Michael R Banitt1, Paul A Sidoti, Ronald C Gentile
1Departments of Ophthalmology, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA.
Insights
Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion effectively manages glaucoma in children with aphakia or pseudophakia. This approach minimizes anterior segment complications, though posterior segment issues may occur.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma Management
- Surgical Interventions
Background:
- Pediatric glaucoma, particularly in aphakic or pseudophakic eyes, presents unique management challenges.
- Traditional glaucoma surgeries may have limitations in this patient population.
Purpose of the Study:
- To assess the efficacy and complications of Baerveldt glaucoma implant (BGI) surgery using pars plana tube insertion in children with aphakic/pseudophakic glaucoma.
- To evaluate intraocular pressure (IOP) control and visual outcomes post-surgery.
Main Methods:
- Retrospective review of 30 pediatric patients (<18 years) with uncontrolled aphakic/pseudophakic glaucoma undergoing pars plana BGI.
- Success defined as final IOP between 5-21 mmHg without further surgery or devastating complications.
- Kaplan-Meier analysis used for outcome evaluation.
Main Results:
- Successful IOP control rates at 12, 24, and 36 months were 85%, 81%, and 72%, respectively.
- Six patients experienced treatment failure.
- Complications included hypotony, retinal detachment, tube obstruction, and visually devastating outcomes in 3 patients.
Conclusions:
- Pars plana BGI is a viable surgical option for pediatric aphakic/pseudophakic glaucoma.
- This technique reduces anterior segment complications like tube-cornea touch.
- Posterior segment complications, while present, were deemed not excessive.
Purpose:
To evaluate the effectiveness and associated complications of Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion in aphakic and pseudophakic children.
Patients And Methods:
The medical records of 30 patients (30 eyes) younger than 18 years old with uncontrolled glaucoma associated with aphakia or pseudophakia who underwent pars plana BGI surgery were retrospectively reviewed. Clinical outcome assessment included the measurement of intraocular pressure (IOP) and visual acuity and the identification of complications. Success was defined as 5 mm Hg
Results:
Mean follow-up after BGI surgery was 29.8+/-26.4 months. Twelve, 24, and 36-month life-table rates for successful IOP control were 85%, 81%, and 72%, respectively. Six of 30 patients were considered failures. Complications included hypotony (5 patients, with 1 developing hemorrhagic choroidals which required surgical intervention and a second progressing to phthisis), retinal detachment (4 patients), tube obstruction (2 patients), pupillary membrane (1 patient), worsening esotropia (1 patient), focal scleral ectasia (1 patient), and loss of light perception (1 patient). Visually devastating complications were observed in 3 patients (hemorrhagic choroidals 1 patient, phthisis 1 patient, loss of light perception 1 patient).
Conclusions:
BGI surgery with pars plana tube insertion is a reasonable option for managing aphakic and pseudophakic children with uncontrolled glaucoma. Complications of BGI surgery related to anterior chamber tube placement, such as tube-cornea touch, are minimized with this approach. The incidence of posterior segment complications, although possibly higher compared with limbal tube insertion, was not excessive.
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