September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Glaucoma drainage device surgery outcomes for pediatric uveitic glaucoma
Author Affiliations & Notes
  • Jonathan C Clarke
    The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Evangelia Gkaragkani
    The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Maria Papadopoulos
    The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Carlos Pavesio
    The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • John Brookes
    The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Peng Tee Khaw
    The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Footnotes
    Commercial Relationships   Jonathan Clarke, None; Evangelia Gkaragkani, None; Maria Papadopoulos, None; Carlos Pavesio, None; John Brookes, None; Peng Khaw, None
  • Footnotes
    Support  The National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6493. doi:
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      Jonathan C Clarke, Evangelia Gkaragkani, Maria Papadopoulos, Carlos Pavesio, John Brookes, Peng Tee Khaw; Glaucoma drainage device surgery outcomes for pediatric uveitic glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6493.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate outcomes of glaucoma drainage devices implantation in children with glaucoma secondary to uveitis.

Methods : This is a retrospective case series of children with uveitic glaucoma who underwent glaucoma drainage device implantation to control intraocular pressure. Surgery was performed by 3 surgeons in a tertiary referral center between 1999 and 2013. Success was defined as an IOP of less than or equal to 21 mmHg with or without additional topical treatment. Further IOP-lowering surgery (additional tube, cyclodiode laser), elevated IOP greater than 21mmHg or loss of light perception acuity was classified as failure. Snellen acuity was converted to LogMAR for statistical analysis.

Results : Surgery was performed in 53 eyes of 41 patients with uveitic glaucoma (underlying diagnosis: idiopathic uveitis n=13, juvenile idiopathic arthritis n=27 and other n=1). Mean age at the time of surgery was 10+/- 2.7 years (range 5-17) with a mean follow-up of 86.5 months +/-55.5, (range 3-193). The type of drainage implant used was: 33 (63.5%) SP Molteno, 13 (25%) Baerveldt 250, 4 (7.7%) Baerveldt 350, 2 (3.8%) Ahmed valves. At final follow up 47 eyes (88.7%) were classified as successes. Further surgery, not indicative of tube failure, included 8 lens extractions, 10 revisions for hypotony, 1 tube exploration, 3 revisions for exposure and 5 bleb needlings. Failed tubes required second tube surgery (n=6). Mean survival = 157.4 months, see Kaplan-Meier figure. There was no significant difference in visual acuity between initial and final examination (0.34 +/- 0.41 vs 0.47+/-0.72, p= 0.44). IOP was reduced from 31.9 +/7.4 to 15.2 +/-4.7 mmHg (p<0.0001) as well as number of glaucoma medications 3.6+/-0.9 vs 1.2 +/-1.4,(p<0.0001).

Conclusions : Refractory pediatric uveitic glaucoma can be managed successfully by glaucoma drainage device implantation. Further interventions are common but visual function is maintained for most patients.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

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