Ahmed to Baerveldt glaucoma drainage device exchange in pediatric patients
Adam Jacobson1, Brenda L Bohnsack2,3
1Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA.
Insights
Exchanging failed Ahmed glaucoma drainage devices (GDD) for Baerveldt GDDs in children with refractory glaucoma improved intraocular pressure control and reduced medication needs. This surgical approach shows promise for pediatric glaucoma management.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Pediatric Ophthalmology
Background:
- Management of encapsulated Ahmed glaucoma drainage devices (GDD) in pediatric refractory glaucoma lacks consensus.
- Few reports exist on surgical interventions for GDDs failing to control intraocular pressure (IOP).
Purpose of the Study:
- To evaluate the outcomes of exchanging Ahmed GDDs for Baerveldt GDDs in children with refractory glaucoma.
- To assess the efficacy and safety of this GDD exchange procedure in a pediatric population.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing Ahmed FP7 removal and Baerveldt 350 GDD placement.
- Surgical success defined as IOP between 5-20 mmHg without further surgery or complications.
- Outcomes assessed included best-corrected visual acuity (BCVA), IOP, and glaucoma medication count.
Main Results:
- Twelve eyes of 10 pediatric patients underwent the GDD exchange.
- The Baerveldt 350 GDD achieved a 75% success rate at final follow-up.
- Significant reductions in IOP (24.1 to 14.9 mmHg) and medication number (3.7 to 2.7) were observed (p < 0.004).
- BCVA remained stable; complications included cycloablation in two eyes and retinal detachment in one.
Conclusions:
- Ahmed GDD removal and Baerveldt GDD placement can effectively improve IOP control and reduce medication dependence in pediatric refractory glaucoma.
- Further studies with larger cohorts and longer follow-up are needed to confirm long-term outcomes.
Background:
There is no consensus and few reports as to the surgical management of encapsulated Ahmed glaucoma drainage devices (GDD) which no longer control intraocular pressure (IOP), especially within the pediatric population. The purpose of this study was to report outcomes of exchanging the Ahmed GDD for a Baerveldt GDD in children with refractory glaucoma.
Methods:
Retrospective review of children (< 18yrs) who underwent removal of Ahmed FP7 and placement of Baerveldt 350 (2016-2021) with ≥ 3-month follow-up. Surgical success was defined as IOP 5-20 mmHg without additional IOP-lowering surgeries or visually devastating complications. Outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications.
Results:
Twelve eyes of 10 patients underwent superotemporal Ahmed FP7 to Baerveldt 350 GDD exchange at 8.8 ± 3.6 years. Time to Ahmed failure was 2.7 ± 1.9 years with 1-, 3-, and 5-year survival rates of 83% with a 95% CI[48,95], 33% with a 95% CI[10, 59], and 8% with a 95% CI[0, 30]. At final follow-up (2.5 ± 1.8 years), success rate for Baerveldt 350 GDDs was 75% (9 of 12 eyes) with 1 and 3-yr survival rates of 100% and 71% with 95% CI[25,92], respectively. IOP (24.1 ± 2.9 vs. 14.9 ± 3.1 mmHg) and number of glaucoma medications (3.7 ± 0.7 vs. 2.7 ± 1.1) were significantly decreased (p < 0.004). BCVA remained stable. Two eyes required cycloablation and 1 eye developed a retinal detachment.
Conclusions:
Ahmed removal with Baerveldt placement can improve IOP control with fewer medications in cases of refractory pediatric glaucoma. However, more eyes with greater follow-up are required to determine long-term outcomes.
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