Glaucoma drainage device surgery in children and adults: a comparative study of outcomes and complications

Abstract

PurposeTo compare the postoperative outcomes and complications of glaucoma drainage device (GDD) surgery in pediatric (<18 years old) and adult patients.MethodsRetrospective, comparative study including all patients who underwent Baervedlt or Molteno device surgery by the same surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and 21 mmHg and a 20% reduction from baseline.ResultsFifty-two children (69 eyes) and 130 adults (145 eyes) were included. Mean IOP and number of medications were significantly reduced postoperatively in both groups. Overall failure rate was similar in children and adults. However, GDD failed earlier in adults than in children. Hypotony was the most common complication in both groups in the first 6 months postoperatively. Later on, bleb encapsulation was more frequent in children, while corneal decompensation tended to be more frequent and occurred earlier in adults. Children also had a higher rate of infectious endophthalmitis and required tube repositioning more frequently than adults.ConclusionsGDD surgery presents different postoperative challenges in children and adults, and the surgeon should remain vigilant for complications throughout the postoperative period, especially for signs of endophthalmitis or bleb encapsulation in pediatric patients. On the other hand, adults may be more prone to early corneal decompensation.

Ab interno tube ligation for refractory hypotony following non-valved glaucoma drainage device implantation

“…However, non-valved shunts have a greater 5-year risk of hypotony and its related complications when compared to valved shunts [5,6]. Although early hypotony following non-valved GDDs has been reported to occur in as much as 39% of eyes [3,7], the incidence of persistent hypotony is far less common, with reports in the literature ranging from 0% to 13%, which is in keeping with our rate of 4.4% [6,[8][9][10]. The variation is likely to be due to a difference in case-mix between studies, with those studies having higher proportions of complex eyes (chronic uveitis, trauma, prior cyclo-destructive procedures or neovascular glaucoma) being more likely to have greater rates of persistent hypotony.…”

“…We used Mitomycin C (MMC) during GDD implantation in 83% of eyes in this series, based on a previous study that demonstrated that intraoperative use of MMC was not significantly associated with hypotony or low IOP at 3 and 5 years [3]. Our experience is that early hypotony within the first 3 months is due to over-drainage rather than MMC use.…”

“…A standard surgical technique was performed for implantation of the GDD in all cases, as has been previously described [3]. In brief, all cases had placement of a full-length intraluminal occluding 3/0 polyamide stent suture (Supramid, S. Jackson Inc., Alexandria, VA, USA) as well as external tube ligation with a 6/0 polyglactin absorbable suture, to prevent excessive early postoperative filtration.…”

Glaukomchirurgie bei Vorderabschnittsdysgenesien

“…Es ist denkbar, dass dies die postoperative Fibrosierung der Tenonkapsel beeinflusst. Die Langzeitergebnisse der AVB-und ABC-Studie bei Erwachsenen zeigen zumindest eine bessere Drucksenkung mit dem Baerveldt-Implantat [31,32] [34,35,37,40]. Bei jugendlichen oder erwachsenen Patienten kann, je nach Voroperationen (Aphakie, Z. n. Vitrektomie), eine alternative Schlaucheinlage, z.…”

Baerveldt Scleral Patch Graft Abscess Secondary to Coagulase-Negative Staphylococcus

“…Known complications of GDD surgery include intraocular bleeding, choroidal detachment, erosion of the conjunctiva, hypotony, corneal decompensation, strabismus, tube obstruction, tube exposure, and infection [ 3 , 4 ].…”