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SJ Kruger, MH White, ME Wilson, RA Saunders, AR Kent; Baerveldt Seton Implantation in Pediatric Patients . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3414.
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Purpose: Pediatric glaucomas provide difficult management challenges to the ophthalmologist. The initial treatment of choice for congenital glaucoma is usually goniotomy or trabeculotomy. However, when these procedures fail to control intraocular pressure (IOP), the choice of secondary surgery is not well established. The use of Ahmed, Molteno, and Baerveldt implants has been described in a limited number of patients. We report our experience using the Baerveldt implant in a consecutive series of 21 eyes of 18 patients. Methods: A retrospective chart review of 21 eyes from 18 children under 21 years of age who underwent Baerveldt 250 or 350 seton implantation between 1996 and 2001 was performed. All patients were seen at the same academic institution and had surgery performed by a single surgeon. All cases have venting slits and an occluding 3-0 Supermid stent as previously described by Sherwood et al. Results: The preoperative diagnosis of glaucoma varied; seven patients had «primary» glaucoma (infantile, WAGR syndrome, Lowe syndrome), while 11 had «secondary» glaucoma (aphakic, Sturge-Weber, aniridia, trauma, inflammatory, neovascular). The mean preoperative IOP was 36.7 mmHg (range 11-50) with a mean of 2.0 medications (range 0-5). The mean number of prior intraocular procedures was 1.6 (range 0-4). The mean IOP decreased to 16.6 mmHg (range 5-35) at 3 months post-operatively (p<0.00001). At the most recent visit, IOP was 15.8 mmHg (range 0-30) at a mean follow up time of 15 months (range 1-65). Four eyes had an IOP≷21 mmHg. Severe complications occurred in 4 eyes (endophthalmitis, corneal graft rejection, and retinal detachment). Aphakic patients did not seem to have a worse prognosis than did phakic patients as previously reported. Conclusion: Baerveldt setons can control glaucoma in pediatric patients who have failed other means of IOP control.
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