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Combined vitrectomy and glaucoma drainage device implantation surgical approach for complex pediatric glaucomas

Cem Ozgonul1, Cagri G Besirli1, Brenda L Bohnsack1

  • 1Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|March 4, 2017
PubMed

Insights

This study shows that combining vitrectomy with a posterior glaucoma drainage device (GDD) effectively lowers intraocular pressure (IOP) in children with complex pediatric glaucomas. The procedure demonstrated a significant IOP reduction and a 65% success rate, offering a viable treatment option.

Area of Science:

  • Ophthalmology
  • Pediatric Glaucoma Surgery
  • Glaucoma Drainage Devices

Background:

  • Pediatric glaucoma often presents complex challenges requiring advanced surgical interventions.
  • Traditional glaucoma surgeries may have limitations in managing severe pediatric cases.
  • The efficacy of combined vitrectomy and posterior glaucoma drainage device (GDD) implantation needs evaluation in pediatric populations.

Purpose of the Study:

  • To assess the effectiveness of a combined surgical technique involving vitrectomy and a posteriorly placed glaucoma drainage device (GDD).
  • To evaluate the impact of this combined approach on lowering intraocular pressure (IOP) in pediatric patients.
  • To determine the success rate and complication profile of this surgical strategy in complex pediatric glaucomas.

Main Methods:

  • Retrospective review of medical records for pediatric patients who underwent vitrectomy with a posteriorly placed GDD.
  • Inclusion criteria required a minimum of 6 months' follow-up, analyzing the first eye operated on per patient.
  • Success was defined by achieving an intraocular pressure (IOP) between 5-20 mm Hg without further IOP-lowering surgery or devastating complications.

Main Results:

  • A total of 20 pediatric patients were included, with diverse etiologies including primary infantile-onset glaucoma and microphthalmia.
  • Mean IOP significantly decreased from 27.2 ± 10.1 mm Hg to 14.5 ± 6.8 mm Hg (P < 0.0001), with a 65% overall success rate.
  • Endoscopic vitrectomy was beneficial for eyes with corneal opacification; vision remained stable or improved in 85% of cases.

Conclusions:

  • Combined vitrectomy and posterior GDD implantation is an effective method for reducing IOP in complex pediatric glaucomas.
  • Endoscope-assisted vitrectomy is a valuable adjunct for cases involving corneal opacity.
  • The complication rates associated with this combined approach appear comparable to traditional anterior chamber procedures.
Abstract

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