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Kim Le, Xihui Lin, Jess T Whitson; Baerveldt Glaucoma Implant for Pediatric Glaucoma in an Underserved Inner-City Population. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6492.
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© ARVO (1962-2015); The Authors (2016-present)
The underlying cause to the majority of pediatric glaucoma is anterior chamber dysgenesis that obstructs aqueous humor outflow. Surgery has been the main treatment of pediatric glaucoma, and the initial procedures of choice are goniotomy or trabeculotomy. Glaucoma drainage implants have been increasingly popular as an alternative treatment for intractable pediatric glaucoma. In this study, we reviewed our experience with the Baerveldt glaucoma implant (BGI) in one of the largest inner-city underserved cohorts.
IRB approval was obtained from the Children’s Medical Center of Dallas. A retrospective chart review was performed for all patients from 2 to 19 years of age who underwent BGI surgery between 2011 to 2015. Preoperative data included glaucoma etiology, age, intraocular pressure (IOP), and prior glaucoma treatments. Post surgery IOPs were followed at 3-6, 6-9, and 12-24 months after surgery. Success was defined as IOP control between 6-24 mmHg without the need for further surgical intervention or loss of light perception. Kaplan-Meier survival analysis was done.
37 eyes of 28 patients were included. The mean patient age was 7.7 +/- 3.73 years (range 1 to 14 years old) with a male predominance of 67.74%. 41.93% were Hispanic and 25.80% were white. 29.03% were primary congenital glaucoma and the rest were secondary to aphakia, Sturge Weber, Trauma, and other etiologies. Overall, the success rate of the BGI as a primary glaucoma surgery was 69.2% and as a secondary surgery was 85.7%. The mean preoperative IOP was 31.6 +/- 5.53 mmHg and the mean postoperative IOP was 20.93 +/- 8.26 mmHg at an average of 18.96 months (p=<0.0001). The number of glaucoma medications decrease from 3.5 before surgery to 2.5 medications at the last follow up (p=0.01). At 40 months, the overall success rate was 77.7%, with 16.12% of the patient requiring other surgical interventions for IOP control. In a sup-group analysis, those who had BGI combined with pars plana vitrectomy (n=9) had a similar success rate of 77.7%.
BGI was successful in controlling the IOP in the majority of the patients in an inner-city cohort who more commonly had secondary glaucoma. Overall, there was a trend towards higher success rate when BGI was done after a previous glaucoma surgery.
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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