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Risk factors for receiving both scleral buckle and glaucoma drainage device in children
Mariana Abi Karam1, Arjun Sharma1, Ashley Lopez-Canizares1
1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street .450N, Miami, FL, 33136, USA.
Scientific Reports
|October 25, 2024
Summary
Pediatric patients needing both a glaucoma drainage device (GDD) and scleral buckle (SB) surgery face higher risks if they have a history of trauma or use multiple glaucoma medications. Trauma significantly increases the likelihood of needing both procedures.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Glaucoma Management
Background:
- Glaucoma drainage devices (GDD) and scleral buckles (SB) are surgical interventions for pediatric glaucoma and retinal detachment, respectively.
- Understanding the risk factors for requiring both GDD and SB in pediatric patients is crucial for surgical planning and patient counseling.
- Previous studies have not comprehensively evaluated the sequential need for GDD and SB in pediatric populations.
Purpose of the Study:
- To identify risk factors associated with pediatric patients requiring a glaucoma drainage device (GDD) after initial scleral buckle (SB) surgery.
- To identify risk factors associated with pediatric patients requiring a scleral buckle (SB) after initial glaucoma drainage device (GDD) implantation.
- To analyze the indications and timing for secondary procedures in pediatric eyes undergoing GDD or SB surgery.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing either SB or GDD surgery between 2013 and 2021.
- Two groups were analyzed: 'SB-first' (SB placement with no prior GDD) and 'GDD-first' (GDD implantation with no prior SB).
- Statistical analysis, including hazard ratios (HR), was used to determine risk factors for requiring the alternative device.
Main Results:
- In the SB-first group (133 eyes), 9% required subsequent GDD implantation. Trauma (HR 4.81) and each additional glaucoma medication pre-SB (increased risk by 1.81) were significant risk factors.
- Common indications for SB-first surgery included retinal detachment (41.2%), blunt trauma (21%), and pathologic myopia (11%).
- In the GDD-first group (135 eyes), 3% required subsequent SB implantation. Trauma was the only statistically significant risk factor (HR 12.3).
Conclusions:
- Pediatric eyes with a history of trauma or multiple pre-existing glaucoma medications have a significantly higher risk of requiring both SB and GDD.
- Ophthalmologists should carefully consider these risk factors when planning initial surgical interventions for pediatric glaucoma and retinal conditions.
- Further research may explore preventative strategies for patients identified as high-risk.
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