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Published on: February 15, 2022
Outcomes and lessons learned from two decades' experience with glaucoma drainage device implantation for refractory
Tanya S Glaser1, Landon C Meekins1, Sharon F Freedman1
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Insights
Glaucoma drainage devices (GDDs) effectively treat pediatric glaucoma in Sturge-Weber syndrome (SWS), but complications are frequent. Modifications are suggested to improve GDD safety in these complex cases.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma
- Sturge-Weber Syndrome
Background:
- Pediatric glaucoma associated with Sturge-Weber syndrome (SWS) presents unique management challenges.
- Refractory cases often require surgical intervention beyond initial treatments.
Purpose of the Study:
- To evaluate the efficacy and safety of glaucoma drainage device (GDD) implantation for pediatric glaucoma in patients with SWS.
- To identify complications associated with GDDs in this specific patient population.
Main Methods:
- Retrospective review of 22 eyes of 22 children with SWS-associated glaucoma treated with GDDs over 20 years.
- Success defined by intraocular pressure (IOP) control, absence of further IOP-lowering surgery, and no sight-threatening complications.
- Kaplan-Meier analysis used for survival rates.
Main Results:
- GDD implantation showed high success rates at 1 year (91%), decreasing to 52% at 5 years.
- Complications occurred in 50% of eyes, with 23% experiencing multiple issues.
- Severe vision-threatening complications included infection, hypotony, and cilioretinal artery occlusion.
Conclusions:
- Glaucoma drainage devices are an effective treatment option for refractory pediatric glaucoma in Sturge-Weber syndrome.
- A significant rate of complications necessitates careful surgical planning and potential modifications for enhanced safety.
Purpose:
To evaluate glaucoma drainage device (GDD) implantation for refractory pediatric glaucoma associated with Sturge-Weber syndrome (SWS).
Methods:
The medical records of consecutive children with SWS-associated glaucoma at a single center who were treated by a single surgeon using GDDs over 20 years were reviewed retrospectively. The main outcome measure was GDD treatment success, defined as absence of any of the following indications of treatment failure: (1) intraocular pressure (IOP) of >21 mm Hg on two consecutive visits despite maximal medical therapy, (2) additional IOP-lowering surgery, and (3) sight-threatening complications.
Results:
A total of 22 eyes of 22 children were included. The median age at glaucoma diagnosis was 0.73 years (range, 0.06-13.2), and the median age at GDD surgery was 4.8 years (range, 0.6-13.3). Most eyes (14 [68%]) had prior glaucoma surgery. Mean follow-up was 2.8 ± 1.5 years. Success (95% confidence interval) by Kaplan-Meier analysis for GDD surgery at 1, 3, and 5 years was 91% (68-98), 75% (50-89), and 52% (24-73), respectively. Failure occurred in 8 eyes (36%). Complications were common, occurring in 50% of eyes, with 23% of eyes having more than one complication. Severe vision-threatening complications (n = 3) included one case each of possible infection requiring GDD removal, persistent hypotony, and cilioretinal artery occlusion.
Conclusions:
GDDs are an effective treatment for SWS-associated glaucoma but have a high rate of complications. We report several severe complications that prompted surgical modifications for increased safety when implanting GDDs in eyes with SWS-associated glaucoma.
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