Combined corneal transplant, glaucoma drainage implantation and pars-plana vitrectomy outcomes in a pediatric population

Abstract

Purpose : The combination of glaucoma drainage device (GDI), pars-plana vitrectomy (PPV) and corneal transplantation is well reported in adults. However, little is known about the outcomes of such combined procedures in pediatric patients. Here we present a retrospective, single center, observational clinical study to evaluate the safety and clinical outcomes of concurrent GDI and or PPV with corneal transplantation procedures in patients 18 years and younger.

Methods : We retrospectively examined the medical records of 41 pediatric patients (ages 0-18 years) who received either corneal transplants or keratoptosthesis (KPro) in combination with at least one additional procedure (either GDI and/or PPV) at the Illinois Eye and Ear Infirmary, Chicago, IL (2003-2017). Primary outcomes included vision, intraocular pressure (IOP), and cup-to-disc ratio (C/D). Secondary outcomes included number of repeat surgeries, intraoperative and postoperative complications.

Results : Forty-one were included in the study with mean age of 8.8 years and average follow-up duration of 61.3 months. Eighteen patients received corneal surgery, GDI, and PPV; 5 received corneal and GDI surgery; 18 received corneal and PPV surgery. Comparing the final visits (mean 56.4 months post-operative) to the pre-operative visits in the patients with all three surgeries, 60% patients experienced an increase in vision with an average improvement of 2.9 lines. Average IOP decrease was -13.37, and C/D increased by 0.11. Eighty-three percent of patients had at least one subsequent surgery, with an average of 2.8 surgeries (0.83 cornea, 0.89 glaucoma, 1.06 retina) following their initial combined procedures. Seventy-two percent of patients experienced complications, including GDI exposure/extrusion, retinal detachments, Kpro extrusion, and corneal graft opacification.

Conclusions : Combined keratoplasty, GDI and PPV appears to be effective in the management of complex pediatric eye disease. Following combined cornea, glaucoma, and retina procedures, vision and IOP improved while C/D slightly worsened. However, the majority of patients had at least one surgical complication and needed at least one additional surgery. Because of the high risk of complications in this vulnerable patient population, careful consideration must be taken when determining a patient’s surgical candidacy for combined cornea/glaucoma/retina procedures.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.