Management of Pediatric Aphakic Glaucoma With Vitrectomy and Tube Shunts

Elshatory, Yasser; Gauger, Elizabeth H.; Kwon, Young H.; Alward, Wallace L.M.; Boldt, H. Culver; Russell, Stephen R.; Mahajan, Vinit B.

doi:10.3928/01913913-20160818-01

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…We did not routinely encounter vitreous in the anterior chamber because all cataract surgeries were performed with vitrectomy with the removal of a posterior vitreous border membrane. However, over time, the posterior vitreous may become loose and may incarcerate the tube in aphakic eyes where there was aphakic without vitrectomy at the time of the GDD implantation [21][22][23][24]. Vigilant observation for incarceration is required over the patient's lifetime, along with appropriate treatment [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

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Paul Glaucoma Implant following Congenital Cataract Surgery in a Pediatric Cohort

Mendoza-Moreira,

Voigt,

Stingl

et al. 2024

JCM

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Background: The aim of this study was to evaluate the short-term efficacy and safety of the Paul Glaucoma Implant (PGI) in pediatric eyes diagnosed with glaucoma following congenital cataract surgery (GFCS). Methods: A retrospective, single-center, descriptive study was conducted on consecutive children diagnosed with GFCS who underwent PGI implantation between July 2022 and November 2023 at the University Medical Center Mainz. The primary outcome measure was the reduction in IOP at the last follow-up visit. Results: Ten eyes of nine children were included in the study. The mean follow-up time was 7.70 ± 4.22 months (4.68–10.72 months). At the end of the study follow-up, the mean (95% CI) reduction in IOP was −14.8 ± 8.73 mmHg (−8.56 to −21.04 mmHg, p < 0.001). At the last follow-up, 30.0% (3/10) of patients achieved an IOP (intraocular pressure) of ≥6 and ≤21 mmHg with a reduction in IOP of ≥25% without treatment, while 90.0% (9/10) achieved this target IOP regardless of glaucoma medication treatment. The mean number of antiglaucoma medications was significantly reduced from 3.50 (IQR = 1) to 2.0 (IQR = 2, p = 0.01), and the visual acuity logMAR improved from 1.26 ± 0.62 to 1.03 ± 0.48 (p = 0.04). Only one eye experienced numerical hypotony (4 mmHg) without choroidal detachment or anterior chamber shallowing within the first 24 h. No other adverse events were observed during the follow-up period. Conclusions: PGI implantation significantly lowered IOP and the number of antiglaucoma eye drops with a favorable safety profile in children diagnosed with GFCS, thereby achieving a high rate of qualified surgical success in the short term.

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Section: Discussionmentioning

confidence: 99%

“…However, over time, the posterior vitreous may become loose and may incarcerate the tube in aphakic eyes where there was aphakic without vitrectomy at the time of the GDD implantation [21][22][23][24]. Vigilant observation for incarceration is required over the patient's lifetime, along with appropriate treatment [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Paul Glaucoma Implant following Congenital Cataract Surgery in a Pediatric Cohort

Mendoza-Moreira,

Voigt,

Stingl

et al. 2024

JCM

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“…GDD is applied in the anterior chamber as a shunter to draw the aqueous humor through a tube to a subconjunctival end-plate, including valved (Ahmed glaucoma valve) and nonvalved (Molteno and Baerveldt implants) designs. GDD implantation is currently among the most widely used treatments for GFCS 23,81,85,89–100…”

Section: Treatmentmentioning

confidence: 99%

“…GDD implantation is currently among the most widely used treatments for GFCS. 23,81,85,[89][90][91][92][93][94][95][96][97][98][99][100] A success rate of up to 95% has been achieved; however, there is no consensus on the diagnostic criteria of success. Several studies have demonstrated that success rate decreases with time.…”

Section: Gdd Implantationmentioning

confidence: 99%

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

Song

Zhou

Bai

et al. 2023

Asia-Pacific Journal of Ophthalmology

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Glaucoma following cataract surgery (GFCS) remains a serious postoperative complication of pediatric cataract surgery. Various risk factors, including age at lensectomy, intraocular lens implantation, posterior capsule status, associated ocular/systemic anomaly, additional intraocular surgery, and a family history of congenital cataract and GFCS, have been reported. However, the optimal surgical approach remains unclear. This review evaluates the diagnostic criteria, classification, risk factors, mechanism, and surgical management, especially the efficacy of minimally invasive glaucoma surgery, in GFCS, and aims to propose an optimal clinical management strategy for GFCS. The results of our review indicate that ab interno trabeculotomy (goniotomy) may be the most appropriate first-line treatment for GFCS.

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“…Some recent studies tend to choose glaucoma drainage devices (GDD), such as Ahmed glaucoma valve (AGV), as first-line procedure because of their favourable risk profile and long-term success. 14–17…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Ahmed glaucoma valve in paediatric glaucoma following congenital cataract surgery in persistent foetal vasculature

Spiess

Calvo

2020

European Journal of Ophthalmology

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Purpose To evaluate the outcomes of primary Ahmed glaucoma valve in refractory secondary glaucoma following congenital cataract surgery, particularly in persistent foetal vasculature. Method Retrospective review of paediatric patients after Ahmed glaucoma valve implantation for refractory post-lensectomy glaucoma in a tertiary referral centre in Spain. Surgical complications, additional and/or replacements of Ahmed glaucoma valve, intraocular pressure, cup-to-disc ratio, glaucoma medications and final visual acuity were studied. Results A total of 29 eyes, 41% with persistent foetal vasculature and 59% with non–persistent foetal vasculature were included with mean follow-up of 105 ± 67 and 74 ± 45 months, respectively, after first Ahmed glaucoma valve implant. Median survival time for the first Ahmed glaucoma valve was significantly lower in persistent foetal vasculature (7.0 ± 3.2 months) compared to non–persistent foetal vasculature (over 129 months), p = 0.001. The cumulative probability of success in persistent foetal vasculature and non–persistent foetal vasculature eyes with Ahmed glaucoma valve were, respectively, 37.5% and 88.2% at year 1 and 28.1% and 71.9% at year 5. Cox regression model suggested persistent foetal vasculature as predictive risk factor of time to Ahmed glaucoma valve failure (hazard ratio: 5.77, p = 0.004). Four eyes developed phthisis bulbi. Mean intraocular pressure prior glaucoma surgery was 32.66 ± 6.73 mmHg and decreased to 16.54 ± 2.75 mmHg (p < 0.001) at final visit. The most frequent early postoperative complication was severe hypotony (32.6%) which tended to be self-limiting. Vitreous haemorrhage was associated with persistent foetal vasculature (p = 0.024). Ahmed glaucoma valve replacements after complications and additional Ahmed glaucoma valve implantations due to unsatisfactory intraocular pressure were more common in the persistent foetal vasculature group. Conclusion Eyes with persistent foetal vasculature and secondary glaucoma after congenital cataract surgery followed by AGV implantation had a higher number of complications and a decreased probability of success compared to the non-persistent foetal vasculature group. Both groups achieved a significant decrease in intraocular pressure; thus, Ahmed glaucoma valve may be considered as first-line treatment in refractory glaucoma following congenital cataract surgery.

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Management of Pediatric Aphakic Glaucoma With Vitrectomy and Tube Shunts

Abstract: Combined vitrectomy and placement of a glaucoma tube shunt can be safe and effective in lowering IOP based on mean IOP values and number of glaucoma medications at 1 year. [J Pediatr Ophthalmol Strabismus. 2016;53(6):339-343.].

Cited by 9 publications

References 10 publications

Paul Glaucoma Implant following Congenital Cataract Surgery in a Pediatric Cohort

Paul Glaucoma Implant following Congenital Cataract Surgery in a Pediatric Cohort

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

Outcomes of Ahmed glaucoma valve in paediatric glaucoma following congenital cataract surgery in persistent foetal vasculature

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