Abstract
Purpose :
To evaluate the long-term outcomes and safety profile of tube implants in primary and secondary paediatric glaucoma patients (≤ 16 years of age) at a tertiary centre.
Methods :
Between January 2005 and August 2020, 361 paediatric glaucoma patients had a tube implant. Of these, 121 were analysed and 83 eyes were included as a first tube implant with sufficient follow-up of at least 12 ± 2 months. This is a retrospective data collection. Failure was defined as loss of light perception (PL) vision, tube explantation, need for oral Acetazolamide or further glaucoma surgery. Eyes that did not fail by the above criteria, but were on supplemental topical medical therapy were considered qualified successes. Eyes that did not failed and were not on any medical therapy were considered complete successes.
Results :
The mean age at surgery was 8.1 ± 5.3 years (55.4% female). The average intraocular pressure (IOP) at listing was 28.1 ± 7.2 mmHg, on 3.1 ± 0.9 medications with 27 (32.5%) patients taking oral Acetazolamide. The mean follow-up time was 3.4 ± 2.0 years. One year after tube implant [7 Ahmed valves (8.4%), 1 Molteno tube (1.2%), 75 Baerveldt tubes (90.4%) n=79], the IOP decreased to 14.8 ± 4.2 mmHg on 2.6 ± 1.0 medications. The average IOP was 15.7 ± 4.7 mmHg on 2.4 ± 0.8 medications after 3 years (n = 46) and 15.1 ± 5.5 mmHg on 2.6 ± 0.7 agents after 5 years (n = 26).
The average visual acuity (VA) was 0.6 ± 0.51 logMAR at listing. At one year follow up, VA was 0.6 ± 0.6 logMAR; at three years VA was 0.6 ± 0.6 logMAR and at 5 years, VA was 0.7 ± 0.5 logMAR (p> .05).
Altogether, one patient lost PL (1.2%) four years post-op, one tube was explanted and replaced with another tube due to poor IOP control (1.2%) and further eight (10%) patients needed additional glaucoma surgery.
Conclusions :
Despite the inherent risk in the paediatric population, tube implants appear to be an effective procedure driving drastic reduction in pressure (p< .00001 at all times) as well as in use of medication in long-term (p< .00001 at all times). This study provides information about the safety profile of tube implants in a paediatric glaucoma population of a single hospital. New evidence of tube implant in glaucoma has changed adult glaucoma management in the last decade. We hope our study can show tube implants as a safe procedure and one more option for children who will need follow up and treatment for a lifetime.
This is a 2021 ARVO Annual Meeting abstract.