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The Long-term Outcomes of Glaucoma Drainage Device in Pediatric Glaucoma
Achilleas Mandalos1, Rajen Tailor, Tina Parmar
1Birmingham and Midland Eye Centre, Birmingham, UK.
Insights
Glaucoma drainage device (GDD) surgery shows long-term effectiveness in pediatric patients, though a high complication rate is anticipated. Early complication detection is crucial for successful management and optimal outcomes in children with glaucoma.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Management
Background:
- Pediatric glaucoma presents unique challenges requiring effective long-term management strategies.
- Glaucoma drainage devices (GDDs) are utilized for complex pediatric glaucoma cases.
- Evaluating the long-term safety and efficacy of GDDs in children is essential.
Purpose of the Study:
- To assess the long-term outcomes and safety profile of glaucoma drainage device (GDD) implantation in pediatric patients.
- To determine the cumulative success rates and identify risk factors for failure in pediatric GDD surgery.
Main Methods:
- Retrospective, noncomparative study of pediatric patients (<18 years) undergoing Baerveldt or Molteno GDD implantation.
- Mitomycin-C used in most cases; success defined as postoperative intraocular pressure (IOP) 6-22 mm Hg with a 20% IOP reduction.
- Analysis of 69 eyes from 52 patients with a mean follow-up of 45.7 months.
Main Results:
- Significant reductions in mean IOP and antiglaucoma medications were observed postoperatively.
- Cumulative qualified success rates were 95.6% at 1 year, declining to 71.3% at 5 years and 39.7% at 8 years.
- Common complications included hypotony (39.1%), bleb encapsulation (16.4%), and endophthalmitis (5.8%). Non-white ethnicity and prior cyclophotocoagulation increased failure risk.
Conclusions:
- Glaucoma drainage device surgery offers adequate long-term control for pediatric glaucoma.
- A high complication rate is expected, but most are manageable with prompt recognition.
- Close monitoring and early intervention are vital for optimizing long-term visual outcomes in pediatric GDD patients.
Purpose:
To evaluate the long-term outcomes and safety of glaucoma drainage device (GDD) in pediatric patients.
Methods:
Retrospective, noncomparative study including all patients below 18 years old who underwent Baerveldt or Molteno GDD implantation by a single surgeon. Mitomycin-C was used in most cases. Success was defined as postoperative intraocular pressure (IOP) between 6 and 22 mm Hg and a 20% reduction in IOP.
Results:
Sixty-nine eyes of 52 patients were analyzed. Mean follow-up length was 45.7±25.2 months (range, 6 to 101 mo). At last postoperative visit, mean IOP and median number of antiglaucoma medications had been significantly reduced from baseline. Cumulative probability of qualified success was 95.6% at 1 year and declined to 71.3% at 5 years and 39.7% at 8 years. Multivariate analysis showed that non-white patients and previous history of cyclophotocoagulation had higher risks of failure at 5 years. Hypotony was the most common complication (39.1%) in the first 6 months postoperatively. Bleb encapsulation occurred in 16.4% of patients. Endophthalmitis occurred in 5.8% of cases and necessitated removal of the GDD.
Conclusions:
GDD surgery can work adequately in children in the long term. A relatively high complications rate should be expected, but in most cases these can be managed successfully. Early recognition of complications is necessary to ensure a good outcome.
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