Novel surgical implants in the treatment of childhood glaucoma

Conventional glaucoma drainage devices (GDDs), such as the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant, are widely used in childhood glaucoma. Recently, newer surgical options, including the PRESERFLO microshunt, Paul Glaucoma Implant (PGI), eyePlate-S, and ClearPath, have emerged with potential advantages to childhood glaucoma patients. This review summarizes current evidence regarding the design, outcomes, and safety profiles of these newer implants in childhood glaucoma patients.

The PRESERFLO offers a minimally invasive approach with favorable safety and intraocular pressure (IOP)-lowering outcomes in small pediatric case series, including eyes with prior GDD implantation. It is typically used with adjunctive mitomycin C. Technical modifications, such as ripcord insertion, reduce the risk of postoperative hypotony.The PGI features a valveless design that enables controlled flow via a 6-0 Prolene ripcord without external ligation. Additionally, its design reduces contact with the corneal endothelium and extraocular muscles. Retrospective series and early randomized data suggest good IOP control with an acceptable safety profile. The eyePlate-S features a valveless design that allows controlled flow through a 5-0 Prolene ripcord, eliminating the need for external ligation. Its tube has an external diameter comparable to the PGI (0.47 mm) but a larger internal diameter (0.18 mm in the eyePlate-S vs. 0.13 mm in the PGI). The eyePlate-200S can also be positioned between extraocular muscles, which may reduce the risk of postoperative diplopia. In addition, the thin, flexible silicone plate can be folded to facilitate implantation.The ClearPath enables flexible implantation in complex pediatric anatomy. Early multiyear results show sustained IOP reduction and decreased medication burden, with a success rate of 79% at 4 years.

Newer devices such as the PRESERFLO, PGI, and ACP demonstrate encouraging mid-term efficacy and safety in the management of childhood glaucoma, particularly in refractory cases or eyes with prior surgeries. While early outcomes are promising, larger comparative studies with extended follow-up are needed to better establish their long-term role relative to conventional GDDs in childhood glaucoma management.