Surgical outcome of tube shunt implantation for pediatric glaucoma

Abstract

Purpose : Pediatric glaucoma is a group of heterogeneous diseases that are often challenging to manage. Glaucoma drainage devices (GDDs) have been widely used to treat refractory glaucoma in adults and showed relatively good long-term intraocular pressure (IOP) control. The use of GDDs in pediatric patients is still limited. This study is to evaluate the surgical outcome of the GDDs in pediatric glaucoma.

Methods : A retrospective chart review was conducted among pediatric glaucoma patients who received GDDs at the Yale Eye Center from 2004 to 2013. Eyes with a minimum of 24-month follow-up were included. Success was defined as the postoperative IOP <21mmHg but > 6mmHg or at least 20% reduction from the baseline with no other glaucoma surgeries or vision-threatening complications.

Results : A total of 10 eyes from 7 pediatric patients were identified. Patients were diagnosed of primary congenital glaucoma (3 eyes, 30%), aphakic glaucoma (2 eyes, 20%), Peters anomaly (1 eye, 10%), Axenfeld-Reiger syndrome (2 eyes, 20%) and Marfan syndrome associated glaucoma (2 eyes, 20%). The mean number of previous surgeries was 1.6 ± 0.7, and the mean age at GDD surgery was 1.6 years (range, 4 months-9 years). Tube shunt devices included Baerveldt 350mm² (30%), Ahmed FP7 (40%), Ahmed FP8 (10%), and Ahmed S2 (20%). The mean preoperative IOP (mmHg) was 29.5 ± 7.9. Postoperatively, it was reduced to 13.0 ± 5.7 at 1 day, 13.7 ± 5.4 at 1week, 15.4 ± 5.0 at 1 month, 15.9 ± 4.7 at 3 months, 12.6 ± 3.0 at 6 months, 14.1 ± 2.1 at 12 months, 13.4± 5.1 at 18 months, 17.7 ± 9.4 at 24 months. Kaplan-Meier analysis showed the success rate at 6 months was 100% followed by a decline to 90% at 12 months, 80% at 18 months, 60% at 3 years, 50% at 4 years, and 40% at 5 years. Uncontrolled IOP elevation was the most common reasons for failure (n=4). Complications within 6 months included cornea/tube touch (n=1) and cornea edema (n=1). Complications beyond 6 months include cataract formation (n=2), tube extrusion (n=1), endophthalmitis (n=1), leakage (n=1), vitreous opacity (n=1), cornea/tube touch (n=1), cornea decompensation (n=1) and posterior synechiae (n=1).

Conclusions : Though IOP outcomes were optimistic within 6 months after GDD implantation, long-term (beyond 6 months) success rate in children declined due to uncontrolled IOP or complications.

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