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Andrew Chen, Fei Yu, Anne L Coleman, JoAnn A Giaconi, Simon K Law, Joseph Caprioli; Ahmed Glaucoma Valves in Pediatric Glaucoma - 10 Year Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3184.
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Evaluation of long-term outcomes of glaucoma drainage devices (GDD) in pediatric glaucoma patients.
This was a retrospective chart review of 136 eyes of 100 consecutive patients diagnosed with pediatric glaucoma who underwent Ahmed Glaucoma Valve (AGV) implantation from 1995 to 2012 at the Jules Stein Eye Institute, with a minimum one year of follow-up. Success was defined as an intraocular pressure (IOP) greater than 5 and less than 22 mmHg with a ≥ 20% reduction from baseline IOP. Failure was defined as not meeting IOP criteria, requiring additional glaucoma surgeries, or loss of light perception.
Mean age at implantation was 7.1 ± 6.2 years. Mean follow-up time was 6.3 years from surgery (range = 1.02 - 17.59 years). Success rates at one and 10 years for all patients were 87.5% and 34.1%, respectively. Success rates for diagnostic subgroups at six years were 24.4% for primary congenital glaucoma, 72.0% for uveitic glaucoma, and 52.1% for other secondary glaucomas. Mean IOP was reduced from 29.3 mmHg preoperatively to 16.6 and 15.0 mmHg after one and 10 years postoperatively, respectively (p-value <0.001 for both). Mean number of medications used was reduced from 2.2 preoperatively to 1.4 at one year (p <0.001) and 1.6 (p-value = 0.05) at 10 years postoperatively. A multivariate Cox regression was used to evaluate risk factors. Eyes with uveitic glaucoma were associated with a risk ratio of 0.35 compared to eyes with primary glaucoma (p = 0.03). Older age in eyes with other secondary glaucoma was associated with a significant risk ratio of 0.94 (p = 0.013). Forty of the 71 eyes that failed required additional GDDs. Two (1.5%) eyes diagnosed with Norrie’s disease had loss of light perception, and 29 (21.3%) did not meet IOP criteria. All nine (6.6%) eyes that underwent penetrating keratoplasty after GDD implantation had abnormal corneas prior to GDD surgery as manifested by Haab’s striae or stromal edema. Five (3.7%) eyes required cataract surgery and three (2.2%) eyes required strabismus surgery after GDD surgery.
GDDs (AGV) have a moderate long-term success with a low rate of serious complications in pediatric glaucoma patients. Those with uveitic glaucoma had a better success rate than those with other diagnoses. For pediatric glaucoma patients who require lifetime control of IOP, GDDs are a viable long-term treatment.
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