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Tube shunts in children translate to lessons learned for adults
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VANCOUVER, British Columbia — Tube shunts may move and run the risk of causing infection, but overall, the devices are fairly safe, according to a speaker here, who shared her experience with tube shunts placed in pediatric patients with glaucoma.
“Some series report up to 35% tube-cornea contact after the initial well-positioned placement of the tube,” Lauren S. Blieden, MD, said at the World Glaucoma Congress.
Lauren S. Blieden
This high rate of movement in children may be accounted by the fact that children have a thinner sclera, which is more pliable against a stiffer implant, Blieden said. Additionally, children grow and they rub their eyes. It has been postulated that eyes shrink once the IOP is controlled, thus moving the originally well-placed tube anteriorly, Blieden said.
The tube-corneal contact likely causes corneal decompensation, although predisposing factors could also be a cause, according to Blieden.
Regarding reports of infection in the literature, “there were surprising rates of endophthalmitis reported, from about 3% up to about 10.5%,” she said.
Children hospitalized with preseptal cellulitis often have underlying sinusitis, Blieden said, with literature reporting rates ranging between 14% and 81%.
“In our collective pediatric experience at the University of Texas at Houston, we’ve had two cases of endophthalmitis associated with tubes that were not eroded,” she said. Both cases were in the setting of sinus disease in children.
“This begs the question: Should we be screening adults for sinus disease and treating sinus disease more aggressively in people who have inferonasal tube shunts?” she asked. “This may be something to look at in the future.”
Disclosure: Blieden has no relevant financial disclosures.