Glaucoma Drainage Devices in Pediatric Glaucoma: A Systematic Review and Meta-Analysis

To evaluate the pooled surgical success rate, postoperative changes in intraocular pressure (IOP) and antiglaucoma medication burden following glaucoma drainage device (GDD) implantation in pediatric glaucoma, with subgroup analyses according to implant type.

A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Web of Science, PubMed, Scopus, and the Cochrane Library were searched on September 16, 2025. Eligible studies included at least 10 pediatric patients undergoing GDD implantation with a minimum follow-up of 3 months and reporting surgical success, IOP, or medication outcomes. Risk of bias in individual studies was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses using the DerSimonian-Laird method were performed for pooled surgical success, IOP reduction, and medication reduction. Subgroup analyses were conducted for Ahmed glaucoma valve (AGV), Ahmed ClearPath (ACP), Baerveldt glaucoma implant (BGI), Aurolab aqueous drainage implant (AADI), and Paul glaucoma implant (PGI).

Twenty-three studies including 1082 pediatric patients (1233 eyes) were analyzed. The overall pooled surgical success rate was 76% (95% CI, 71.1%-80.3%; I² = 73.6%). Subgroup success rates were 70.7% for AADI, 78.9% for ACP, 73.0% for AGV, 82.3% for BGI, and 80.0% for PGI. The pooled mean IOP reduction was -16.14 mmHg (95% CI, -17.06 to -15.21; I² = 88.3%), and the mean reduction in glaucoma medications was -1.63 (95% CI, -1.76 to -1.51; I² = 91.4%). Meta-regression analysis demonstrated that longer follow-up duration was associated with lower surgical success and a smaller reduction in medication use, suggesting that medication requirements increased over time.

GDD implantation in pediatric glaucoma is associated with meaningful IOP reduction, decreased medication burden, and an overall favorable surgical success rate across diverse pediatric glaucoma subtypes. However, substantial heterogeneity, non-uniform success definitions, and declining success with longer follow-up suggest that long-term durability may be limited, and outcomes should be interpreted cautiously, particularly in inter-device comparisons.