Ologen augmentation of Ahmed glaucoma drainage devices in pediatric glaucomas

Abstract

Background Limited data exists on the effectiveness of the collagen matrix, Ologen, on increasing Ahmed glaucoma valve (AGV) success in childhood glaucomas. Methods Ocular examination and surgical details of pediatric patients who underwent AGV placement ± Ologen augmentation between 2012 and 2020. Complete success was defined as intraocular pressure (IOP) between 5 and 20 mmHg without glaucoma medications and additional IOP-lowering surgeries. Qualified success was defined as above, except IOP control maintained with or without glaucoma medications. Results Twenty-two eyes of 16 patients underwent AGV placement of which 6 eyes had Ologen-augmentation (OAGV) and 16 eyes had conventional surgery (CAGV). Average age was 6.4 ± 5.1 years with 4.2 ± 2.5 follow-up years. There was no difference in age, number of previous surgeries, and preoperative IOP and glaucoma medications. At final follow-up, success rate was 100% (5 eyes complete, 6 eyes qualified) in the OAGV group compared to 31% (0 eyes complete, 5 eyes qualified) in the CAGV group. One and two-year survival rates were 100% for OAGV compared to 62 and 38% for CAGV. Postoperative IOP was significantly lower at 1-month and final follow-up (p = 0.02) as was the number of glaucoma medications at 3, 6, 12-months and final follow-up (p < 0.05) in the OAGV group. Conclusions Ologen-augmentation increased the success and survival rates of AGVs in childhood glaucomas. Further, Ologen mitigated the hypertensive phase and decreased medication dependency. Longer follow-up with a greater number of eyes is required to fully evaluate the effectiveness of OAGV.

Outcomes of Baerveldt Glaucoma Drainage Devices in Pediatric Eyes

“…Since all surgeries were performed by a single surgeon, this suggests more uniform criteria for performing surgery and the choice of type and location of the implant as well as greater consistency of the surgical procedure and postoperative management. However, within the last year, we have employed our recently published technique for Ologen-augmentation of Ahmed GDDs as our primary glaucoma tube surgery 28. Since in our hands, Ologen augmentation significantly improves the 1- and 2-year success rates of the Ahmed implant, we have changed our practice pattern such that Baerveldt GDDs are primarily used in select forms of glaucoma (eg, Sturge Weber) and secondarily after a failed, encapsulated Ahmed GDD.…”

“…However, within the last year, we have employed our recently published technique for Ologen-augmentation of Ahmed GDDs as our primary glaucoma tube surgery. 28 Since in our hands, Ologen augmentation significantly improves the 1- and 2-year success rates of the Ahmed implant, we have changed our practice pattern such that Baerveldt GDDs are primarily used in select forms of glaucoma (eg, Sturge Weber) and secondarily after a failed, encapsulated Ahmed GDD. To this point, concurrent explantation of a superotemporal Ahmed with placement of a Baerveldt in the same quadrant was performed in 7 of the surgeries in our cohort with a similar technique that has been shown in adults.…”

“…Failure was defined as IOP <5 mm Hg or > 21 mm Hg (with or without glaucoma medications) for 2 consecutive visits, the need for additional IOP lowering or elevating surgery, or a visually significant complication. 12,13,16,28 Collected data included age, sex, ocular and systemic diagnoses, intraocular surgical details, and surgical complications. Examination findings included preoperative (examination immediately before Baerveldt placement) and final best-corrected visual acuity (BCVA), IOP, and number of glaucoma medications.…”

“…Failure was defined as IOP <5 mm Hg or >21 mm Hg (with or without glaucoma medications) for 2 consecutive visits, the need for additional IOP lowering or elevating surgery, or a visually significant complication. 12 , 13 , 16 , 28 …”

Outcomes of combined endoscopic vitrectomy and posteriorly placed glaucoma drainage devices in pediatric patients

“…All GDD implantations were performed under general anesthesia by the same surgeon (BLB) as previously described [ 3 , 14 ]. GDDs included Baerveldt 101-350 (BV350, Abbott Medical Optics, Santa Ana, CA), Baerveldt 101-250 (BV250, Abbott Medical Optics), Ahmed FP7 (New World Medical, Rancho Cucamonga, CA), and Ahmed FP8 (New World Medical).…”