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Published on: March 10, 2013
Glaucoma drainage implants in pediatric patients
1Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston 02114.
Insights
Drainage implants effectively lower intraocular pressure in pediatric glaucoma cases unresponsive to other treatments. While 80% of cases were successful, patients often require ongoing medication and careful monitoring for complications.
Area of Science:
- Ophthalmology
- Pediatric Surgery
Background:
- Pediatric glaucoma poses significant challenges, often requiring multiple interventions.
- Refractory cases necessitate advanced surgical solutions beyond conventional therapies.
Purpose of the Study:
- To evaluate the efficacy and safety of drainage implants in children with refractory pediatric glaucoma.
- To assess the long-term intraocular pressure control and complication rates.
Main Methods:
- Retrospective review of 20 eyes in pediatric patients (≤10 years) treated with Molteno or Baerveldt implants.
- Analysis of pre- and post-operative intraocular pressure, previous surgical history, and follow-up duration.
Main Results:
- Significant reduction in mean intraocular pressure from 37 mmHg to 18 mmHg.
- Overall success rate of 80% (intraocular pressure ≤21 mmHg) at an average follow-up of 25 months.
- 75% of patients required postoperative glaucoma medications; 23 complications occurred, with one impacting visual acuity.
Conclusions:
- Drainage implants are effective in managing pediatric glaucoma refractory to standard treatments.
- Close postoperative monitoring and medication are frequently necessary.
- Implants offer a viable surgical option for severe pediatric glaucoma cases.
Abstract:
To assess the use of drainage implants in pediatric patients with glaucoma refractory to conventional medical and surgical therapy, we retrospectively reviewed 20 consecutive eyes in children 10 years of age or younger treated with 16 Molteno (three of which were removed and replaced with second Molteno shunts) and seven Baerveldt implants. The age of the patients ranged from 1 month to 10 years (mean, 3 years). The patients had undergone a mean of two previous failed glaucoma procedures (range, one to six). The mean intraocular pressure (IOP) prior to drainage tube implantation was 37 +/- 4 mm Hg, compared with a mean of 18 +/- 6 mm Hg following surgery, with average postoperative follow up of 25 months (range, 8 to 41 months). The overall success, defined as IOP < or = 21 mm Hg without further surgical therapy, was 80%. Postoperative glaucoma medications were required in 75% of patients. There were 23 complications, one of which resulted in decreased visual acuity. These findings demonstrate that drainage tube implants can be effective in lowering IOP in uncontrolled pediatric glaucomas. Patients often require postoperative glaucoma medications and close monitoring for complications.
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