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Niloufar Abdollahi, Andrew Chen, Anne L Coleman, JoAnn A Giaconi, Simon K Law, Fei Yu, Joseph Caprioli; Sequential Glaucoma Drainage Devices in Pediatric Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6135.
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This study evaluates the outcomes of sequential glaucoma drainage devices (GDDs) in pediatric glaucoma patients.
This was a retrospective chart review of 39 eyes of 32 patients who underwent a second Ahmed Glaucoma Valve (GDD) implantation from 1995 to 2012 at the Jules Stein Eye Institute with a minimum of 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 of the second GDD was 6.77 ± 5.66 years. Median time between the two GDD surgeries was 1.7 years with a range from 0.1 to 8.6 years. Mean follow-up time was 5.5 years from the second GDD surgery. Success rate at 6 years was 52% with a median survival of 5.7 years. Mean IOP was reduced from 23.0 preoperatively to 16.9 and 17.9 mmHg at one and 6 years postoperatively, respectively (p < 0.001 and = 0.008, respectively). Mean number of medications were reduced from 1.9 preoperatively to 1.1 at one year postoperatively (p = 0.01). The number of medications at 6 years was the same as preoperatively. Twenty-two (56.4%) eyes had failed by the end of the study. Of these, 14 (35.9%) eyes required additional GDDs, 2 (5.1%) required cyclophotocoagulation, and 1 (2.6%) required removal of the second GDD. Of the 3 (7.7%) eyes that had loss of light perception, one was diagnosed with Norrie’s disease, one had a choroidal hemagioma, and one was enucleated after endophthalmitis developed subsequent to cataract surgery. Six eyes (15.4%) were noted to have strabismus, of which 2 (5.1%) required surgery. Of the 9 (23.1%) eyes first noted to have cataracts after the second GDD, 4 (10.3%) required cataract extraction. Six eyes underwent penetrating keratoplasty after the second GDD was implanted, but all had abnormal corneas prior to GDD surgery as manifested by Haab’s striae or stromal edema. No eyes experienced hypotony or phthisis.
A second GDD (AGV) provides additional IOP control for a median of 5.7 years while avoiding hypotony and phthisis. Risks include a low rate of strabismus and cataract formation. In this study, no corneas decompensated after GDD implantation. Though a second GDD is not without risks, it remains a viable treatment option if pediatric patients require additional surgeries for IOP control.
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