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Risk Factors for Glaucoma Drainage Device Failure and Complication in the Pediatric Population
Charles M Medert1, Kara M Cavuoto1, Elizabeth A Vanner1
1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Insights
Glaucoma drainage device (GDD) implantation in children shows factors influencing failure and complications. Younger age and specific glaucoma types increase risks, but GDDs remain a valuable option for pediatric glaucoma management.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Pediatric glaucoma presents unique challenges compared to adult forms.
- Glaucoma drainage devices (GDDs) are utilized for complex pediatric glaucoma cases.
- Understanding factors affecting GDD outcomes in children is crucial for surgical planning and patient counseling.
Purpose of the Study:
- To identify factors associated with failure and complications following glaucoma drainage device (GDD) implantation in pediatric patients.
- To analyze the long-term outcomes of GDDs in a cohort of children.
- To provide data for comparison with novel glaucoma surgical techniques in children.
Main Methods:
- A retrospective case series design was employed.
- Data from consecutive pediatric patients (<18 years) undergoing GDD implantation between May 1997 and July 2019 were analyzed.
- Surgical failure was defined by elevated intraocular pressure (IOP), IOP reduction criteria, reoperation, or vision loss. Complications included postoperative events requiring further intervention.
Main Results:
- Of 150 first-time GDD implants, 58 (38%) failed over a mean 5.4-year follow-up. Acquired glaucoma types had lower failure risk than non-acquired conditions. Younger age (<3 years) increased complication risk.
- First-time GDD failure risk decreased with increasing age. Higher preoperative IOP and younger age (<3 years) were associated with increased complication risk.
- Second-time GDD implants showed a 50% failure rate, with younger age (<1 year) and concurrent surgeries increasing failure risk.
Conclusions:
- Glaucoma drainage device implantation in children is generally safe and effective, but outcomes must consider the patient's lifespan.
- Factors such as age at implantation, preoperative IOP, and glaucoma etiology significantly impact GDD success rates in pediatric populations.
- These findings establish a benchmark for evaluating future innovative glaucoma surgical procedures in children.
Purpose:
Report factors associated with failure and complication in a cohort of children who have undergone glaucoma drainage device (GDD) implantation.
Design:
Retrospective case series.
Participants:
Consecutive pediatric GDD eyes that met criteria between May 1997 and July 2019.
Methods:
Entries were included for analysis if age <18 years at the time of GDD implantation. Failure was defined as an intraocular pressure (IOP) greater than 21 mmHg or IOP reduction <20% or IOP <5 mmHg at 2 consecutive follow-up visits >3 months after implantation, reoperation for glaucoma, or loss of light perception vision. Complications were defined as postoperative events due to the GDD that required additional examination under anesthesia or additional surgery.
Main Outcome Measures:
Survival analyses of surgical failures and complications.
Results:
Over a mean follow-up period of 5.4 years, 58 (38%) of 150 first-time GDD implants failed. Glaucoma associated with acquired conditions had decreased risk for failure when compared with glaucoma secondary to nonacquired systemic diseases (hazard ratio [HR], 12; P = 0.0063), nonacquired ocular anomalies (HR, 12; P = 0.0054), and primary congenital glaucoma (HR, 5.4; P = 0.041). There was an increased risk of failure for first-time tubes in younger patients with a 23% reduction of failure with each 3-year increase in age (HR, 0.77; P = 0.034). A total of 38 (25.3%) of the first-time GDD implantations had a complication. Higher preoperative IOP (5 mmHg increase; HR, 1.2; P = 0.038) and younger age (<3 years; HR, 2.1; P = 0.024; < 2 years, HR, 1.9; P = 0.046) increased the risk of complication. There were 22 second-time GDD implants in the study, of which 11 failed (50%), and increased risk for failure was associated with younger age at the time of implantation (<1 year; HR, 27; P = 0.0053) and concurrent glaucoma-related procedures with or without non-glaucoma anterior segment surgery at the time of implantation (HR, 13; P = 0.0085).
Conclusions:
Although GDD implantation in children is relatively safe and effective, these data should be interpreted in the context of children's relative longevity. These findings offer an outcome metric to which future novel glaucoma procedures in children can be compared.
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