Two-Staged versus Single-Staged Baerveldt Implantation in Children with Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Pediatric Ophthalmology

Background:

• Glaucoma in children requires effective intraocular pressure (IOP) management.
• Baerveldt glaucoma drainage devices (GDDs) are utilized for pediatric glaucoma.
• Surgical techniques, including staged vs. single-stage implantation, are continuously evaluated.

Purpose of the Study:

• To compare the efficacy and safety of two-staged versus single-staged Baerveldt GDD implantation in pediatric glaucoma patients.
• To assess outcomes such as IOP control, visual acuity, and need for glaucoma medications.

Main Methods:

• Retrospective observational case series comparing children (<18 years) undergoing two-stage Baerveldt implantation (n=25) with age-matched controls receiving single-stage implantation (n=40).
• Data collected included demographics, glaucoma type, prior surgeries, best-corrected visual acuity (BCVA), IOP, and glaucoma medications.
• Success defined as IOP 5-21 mmHg without additional surgeries or devastating complications; survival curves analyzed.

Main Results:

• No significant differences in age, glaucoma type, prior surgeries, follow-up duration, preoperative/final BCVA, IOP, or medication number between groups.
• The two-staged group showed significantly fewer instances of vision worsening (p=0.0011).
• Both groups demonstrated significant IOP reduction (p<0.0001) and decreased medication use (p<0.05). Success rates were 64% (two-stage) vs. 60% (single-stage), with no difference in survival (p=0.6629).

Conclusions:

• Two-staged Baerveldt implantation in children effectively controls IOP with fewer medications compared to single-staged procedures.
• Both surgical approaches offer similar success and survival rates for pediatric glaucoma management.
• Prior glaucoma surgeries increase the risk of GDD failure.