Long-term Clinical Outcomes of Ahmed and Baerveldt Drainage Device Surgery for Pediatric Glaucoma Following Cataract Surgery

Abstract

Precis: In this retrospective case series, both Baerveldt and Ahmed glaucoma drainage devices resulted in good long-term outcomes in eyes with pediatric glaucoma following cataract surgery (GFCS). Background: The aim of this study was to describe the long-term safety and efficacy of primary glaucoma drainage device surgery in patients with pediatric GFCS. Methods: We retrospectively identified 28 eyes of 28 patients with GFCS that underwent tube shunt surgery with the Ahmed Glaucoma Valve or Baerveldt Glaucoma Implant. The primary outcome measure was a surgical failure, defined as intraocular pressure (IOP) >21 mm Hg or not reduced by 20% below baseline on 2 consecutive follow-up visits after 3 months, IOP <5 mm Hg on 2 consecutive follow-up visits after 3 months, and reoperation for glaucoma. Results: The mean duration between cataract removal and the diagnosis of glaucoma was 3.6±1.5 years. Kaplan-Meier survival curves indicated a mean time to failure of 41.9±2.1 months after drainage device surgery. The cumulative probability of failure at 1, 2, 3, and 4 years was 3.6%, 19%, 28%, and 28%. IOP was significantly decreased from 29.3±4.1 mm Hg preoperatively to 17.6±1.6 mm Hg at the final follow-up visit (P<0.001). The number of glaucoma medications at baseline was 3.1±0.6, which decreased to 2.1±0.7 at the final visit (P=0.001). Conclusions: Glaucoma drainage device surgery results in good long-term outcomes in patients with GFCS.

Current approaches to glaucoma surgery in children – glaucoma drainage devices and minimally invasive procedures

“…The mean time from the implantation of the drainage device to the loss of its efficacy was 41.9 ±2.1 months: 42.8 ±2.7 months for Ahmed glaucoma valve and 41.2 ±3.1 months for Baerveldt glaucoma implant (Kaplan-Meier curve) [79]. Three eyes (17.6%) required second valve implantation to control intraocular pressure [79]. A review of the literature covering a period of up to 2020 identified a small number of studies evaluating long-term outcomes of valve reimplantation in the population of children with glaucoma secondary to congenital cataract surgery [79].…”

“…Esfandiari et al evaluated long-term safety and efficacy of surgical procedures using Ahmed and Baerveldt implants in the treatment of childhood glaucoma after cataract surgery in 28 eyes in 28 patients (16 eyes were implanted with Ahmed glaucoma valves, and 12 with Baerveldt implants). The reported incidence of glaucoma developing after congenital cataract surgery varies from 15% to 45% [79,80]. The risk factors include small corneal diameter, young age at surgery and the presence of nuclear cataract.…”

“…The researchers determined the mean time interval to glaucoma diagnosis to be 3.6 ±1.5 years. The mean age at implantation surgery was 4.1 ±1.0 years (4.4 ±2.1 years for the Ahmed glaucoma valve and 4.1 ±1.5 years for the Baerveldt implant) [79].…”

“…The mean time from the implantation of the drainage device to the loss of its efficacy was 41.9 ±2.1 months: 42.8 ±2.7 months for Ahmed glaucoma valve and 41.2 ±3.1 months for Baerveldt glaucoma implant (Kaplan-Meier curve) [79]. Three eyes (17.6%) required second valve implantation to control intraocular pressure [79].…”

Angle Surgery in Pediatric Glaucoma Following Cataract Surgery

“…Trabeculectomy has historically poor success rates in GFCS, precludes contact lens use (which is of great importance in aphakic eyes), and begets bleb-related complications, such as infection, leak, and over filtration [38]. Glaucoma drainage implants have demonstrated superior success rates to trabeculectomy, but also beget greater complication rates, particularly of suprachoroidal hemorrhage in the setting of hypotony, as well as keratopathy due to implant-related endothelial compensation [39][40][41][42][43]. CPC can be difficult to titrate and causes greater inflammation and carries a greater risk of phtisis [35][36][37]44].…”