Clinical Outcomes in Pediatric Patients Undergoing Pars Plana Vitrectomy for Posterior Chamber Placement of Baerveldt Glaucoma Implant

Abstract

Abstract: : Purpose: To describe the surgical outcomes in a series of aphakic children with congenital refractory glaucoma who underwent pars plana vitrectomy for posterior chamber placement of Baerveldt glaucoma implant (PPVPBI). Methods: The charts of all pediatric patients with at least 12 month follow up who underwent PPVPBI at University of California at Davis between January 1, 1992 and September 7, 2002 were reviewed. Main outcome measures included intraocular pressures (IOP), number of glaucoma medications, visual acuity and patency of Baerveldt tube implant, at 12 months postoperatively, and at the last follow up visit. Results:Nine eyes of six patients were identified. Mean age of the patients was 35 months (range 3 months to 10 years). Mean follow up was 37 months (range 12 to 96 months). All patients had a prior history of cataract extraction resulting in aphakia. Mean IOP was lowered form pre–operative level of 31 mmHg (range 23 to 45 mmHg) to 18 mmHg (range 4 to 41 mmHg) at one–year post–operative mark, and was at 19 mmHg (range 6 to 31 mmHg) at the last follow up examination. Mean number of medications administered decreased from 3 (range 2 to 5), preoperatively, to 1 (range 0 to 3), at the last follow up examination. Mean number of re–operations was one, with the range of 0 to 2. Three out of 9 eyes found with vitreous plugging of the Baerveldt tube required one revision, while one eye required two revisions to achieve patency. One eye found with scarring of the Baerveldt plate was treated with 360–degree diode cyclophotocoagulation. One eye with disinserted Baerveldt tube required exchange to a bigger sized Baerveldt. The three remaining eyes were functionally patent without intervention at the last follow up examination. Final visual acuity was the same or improved in all patients. Conclusions:Pars plana vitrectomy with pars plana insertion of Baerveldt glaucoma tube is an effective mean of controlling intraocular pressure in aphakic pediatric population with congenital refractory glaucoma. Vitreous base must be meticulously trimmed, as there is a high rate occlusion of Baerveldt tube from vitreous plugging.

Keywords: vitreoretinal surgery • vitreous