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Charles Maxwell Medert, Kara Marie Cavuoto, M.D., Elizabeth Vanner, Ta Chen Chang; Are Comorbidities and Tube Status Associated with Tube Failures and Complications?. Invest. Ophthalmol. Vis. Sci. 2020;61(7):949.
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Glaucoma drainage device (GDD) implantation failures and complications are sight-threatening, especially in children in the amblyogenic age range. However, factors associated with complications and failure have not been well-investigated in the pediatric population. In this study, we report a large cohort of children who have undergone GDD implantation to determine the relationship between comorbidities and the number of implanted tubes with the likelihood of failure and complication.
All pediatric GDDs implanted between 5/1997 and 7/2019 were reviewed. Failure was defined by intraocular pressure criteria (>21mmHg, reduction <20% or <5mmHg at 3 months after implantation), reoperation for glaucoma, and/or loss of light perception vision. Complications were defined as postoperative events attributed to the GDD requiring surgical intervention. Comorbid conditions were any ophthalmic/systemic diseases or syndromes with known ocular sequelae, in addition to glaucoma.
150 primary tubes and 22 second tubes were identified. Median age was 7.34 years (range 0-17, inter-quartile range 1-13). In eyes with primary tubes, 74 (49.3%) had a comorbidity. Of these, 32 (43.2%) failed and 19 (25.7%) had a complication. Of the 76 that did not have a comorbidity, 26 (34.2%) failed and 19 (25.0%) had a complication. Neither the difference in the risk of failure nor the difference in the risk of complication were significant (p=0.2546 and p=0.6353, respectively). In the 22 eyes with second tubes, 8 of the 13 eyes (61.5%) with a comorbidity failed whereas 3 of the 9 eyes (33.3%) without a comorbidity failed. This difference was marginally statistically significant (p=0.0704). Overall, 58 (38.7%) of primary tubes failed compared to 11 (50%) of secondary tubes. This difference wasn't statistically significant (p = 0.41). Similarly, the difference in the rate of complication wasn't statistically different (p = 0.47) between first and second tubes.
In our cohort, a non-glaucomatous comorbidity did not significantly increase the likelihood of GDD failure or complications. In the treatment of childhood glaucoma, patients with comorbidities may have failure and complication profiles similar to primary congenital glaucoma or juvenile open angle glaucoma patients. Similarly, there may not be a difference in the rate of complication and/or failure when comparing primary and secondary GDD implants.
This is a 2020 ARVO Annual Meeting abstract.
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