Risk Factors for Glaucoma Drainage Device Failure and Complication in the Pediatric Population

Medert, Charles M.; Cavuoto, Kara M.; Vanner, Elizabeth A.; Grajewski, Alana L.; Chang, Ta Chen

doi:10.1016/j.ogla.2020.07.006

Cited by 10 publications

(30 citation statements)

References 13 publications

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“…Importantly that study included 112 Baerveldt and 37 Ahmed implants performed in 119 patients, and although the authors comment that there was no significant difference in success rate between the GDD types, they did not report Ahmed and Baerveldt specific rates. In addition, the study did not account for interdependence of the eyes if GDDs were placed in both eyes of a patient 21. In contrast, in adults there are well known risk factors for surgical failure including younger age, black race, and neovascular and uveitic forms of glaucoma 33,34.…”

Section: Discussionmentioning

confidence: 99%

“…The suprachoroidal hemorrhage followed a combined vitrectomy and stage 2 procedure and the vitreous hemorrhage occurred after a combined vitrectomy and single-staged Baerveldt with venting slits. Interestingly, only a few other pediatric studies reported suprachoroidal hemorrhage as a complication, while choroidal effusions were more commonly noted 14,20,21…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13][14][15]17 Many of the larger studies with longer follow-up in children combine multiple types of GDDs, making it more difficult to measure the individual long-term success of each GDD. [19][20][21] Unlike in the adult population, where a randomized trial comparing Baerveldt and Ahmed GDDs has been performed, there is less data measuring the success of specific GDD types in large cohorts of children. 22 While valved Ahmed GDDs have the benefits of immediate pressure lowering effect and decreased risk of postoperative hypotony, they are plagued with the hypertensive phase and lower rates of overall success.…”

mentioning

confidence: 99%

“…However, many of these reports are limited by the small number of eyes and short time of follow-up 10–15,17. Many of the larger studies with longer follow-up in children combine multiple types of GDDs, making it more difficult to measure the individual long-term success of each GDD 19–21…”

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confidence: 99%

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Outcomes of Baerveldt Glaucoma Drainage Devices in Pediatric Eyes

Jacobson

Besirli

Bohnsack

2021

Journal of Glaucoma

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Précis: In children, Baerveldt implants showed 84% success at 1 year, but decreased to 32% at 8 years. Age, race, and glaucoma type were not risk factors for failure. Concurrent intraocular surgery was associated with complications. Purpose: Evaluate success and risk factors for failure and complications of Baerveldt glaucoma implants in children. Methods: Retrospective case series of children who underwent Baerveldt implant placement (2012-2019 by single surgeon) with ≥1 year follow-up. Ocular examination and surgical details were collected. Failure defined as intraocular pressure (IOP) <5 mm Hg or >21 mm Hg for 2 consecutive visits, need for IOP related surgery, or visually significant complication. Results: One hundred-six eyes of 76 patients underwent 110 Baerveldt placement at median 6.4 years. Baerveldt placement was combined with additional procedures in 49% with vitrectomy most common (30%). Success of first Baerveldt (per patient) was 64% at final follow-up (median 4.7 y). One-, 5-, and 8-year survival rates were 84%, 60%, and 32%, respectively. There was no difference (P=0.97) in survival between first Baerveldt and all Baerveldt surgeries. Failure of first Baerveldt was not associated with sex, age, ethnicity, prior IOP-lowering surgery, concurrent intraocular surgery, or glaucoma type. Complications occurred in 14% and were associated with concurrent surgery. Twenty-six percent required additional IOP-lowering surgery. At final follow-up, IOP and glaucoma medications were significantly decreased (P<0.0001). Eyes underwent an average of 3.8±2.3 ocular surgeries and 3.0±2.0 glaucoma surgeries. Conclusions: Baerveldt implants showed good success initially, but survival rates declined over time. No risk factors for failure of first implanted Baerveldt were identified. Concurrent surgery was associated with complications. Majority of eyes required multiple surgeries to achieve IOP control and preserve vision.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Outcomes of Baerveldt Glaucoma Drainage Devices in Pediatric Eyes

Jacobson

Besirli

Bohnsack

2021

Journal of Glaucoma

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“…Glaucoma drainage devices (GDD) are a well-established treatment for medication-refractory glaucoma in children [ 1 – 4 ]. Tubes are typically placed in the anterior chamber due to ease of placement and good visualization at the slit lamp.…”

Section: Introductionmentioning

confidence: 99%

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

2022

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Background This study aims to describe outcomes of posteriorly-placed glaucoma drainage devices (GDD) with concurrent endoscopic vitrectomy in pediatric patients with glaucoma and corneal opacification. Methods This retrospective case series identified patients under 18 years of age who underwent posteriorly-placed GDD implantation with concurrent endoscopic vitrectomy between 2012 and 2021. Data collected included ocular diagnoses, prior intraocular surgeries, type and position of GDD, surgical complications, and additional surgeries. Preoperative and final visual acuity, intraocular pressure (IOP), number of glaucoma medications, and exam findings were also recorded. Surgical data included type and position of GDD, Success was defined as IOP between 5-21 mmHg without visually devastating complication or need for additional glaucoma surgery. Results Ten patients (14 eyes) with sclerocornea (6), Peters Anomaly (4), corneal decompensation from increased IOP (3), and corneal scar (1) underwent combined endoscopic vitrectomy with posteriorly-placed GDD (Baerveldt (10 eyes), Ahmed (4 eyes)) at 4.6 ± 5.8 years of age. Four eyes of 3 patients remained successful at final follow-up, while 10 eyes of 7 patients required 2.4 ± 1.3 additional surgeries for glaucoma (7) or hypotony (3). Kaplan Meier analysis demonstrated 1- and 2-year survival rates of 36% and 18%, respectively. At final follow-up (3.7 ± 2.4 years), after an average of 4.4 ± 2.4 glaucoma surgeries, 13 of 14 eyes had obtained IOP control on significantly fewer (p<0.0001) IOP-lowering medications. Additional complications included retinal detachment (2), chronic corneal graft failure (2), phthisis (1) and band keratopathy (1). Conclusions Management of glaucoma in pediatric eyes with corneal opacification is challenging and often requires multiple surgeries. A combined endoscopic vitrectomy and posteriorly placed GDD is a viable technique to establish aqueous humor outflow. Although the success rate is low, this surgical approach may be useful in ultimately obtaining IOP control and preserving vision in these complex eyes.

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Ologen augmentation of Ahmed valves in pediatric glaucomas

Jacobson

Bohnsack

2022

Journal of American Association for Pediatric Ophthalmology and

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Risk Factors for Glaucoma Drainage Device Failure and Complication in the Pediatric Population

Cited by 10 publications

References 13 publications

Outcomes of Baerveldt Glaucoma Drainage Devices in Pediatric Eyes

Outcomes of Baerveldt Glaucoma Drainage Devices in Pediatric Eyes

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

Ologen augmentation of Ahmed valves in pediatric glaucomas

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