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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
PubMed

Insights

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.

Keywords:
Glaucoma drainage deviceOcular traumaPediatric eyesScleral buckle

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