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Second glaucoma drainage device offers moderate long-term success for pediatric glaucoma
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Implantation of a second glaucoma drainage device for the treatment of refractory pediatric glaucoma was shown to have moderate success over time, according to study results.
Researchers retrospectively reviewed Duke University’s surgical records from 1997 to 2012 and identified 43 eyes of 37 patients with two or more drainage devices, refractory pediatric glaucoma and a minimum of 6 months of postoperative follow-up data.
Patients were implanted with either an Ahmed (New World Medical) or Baerveldt (Abbott Laboratories) glaucoma device. Device failure was classified as IOP of greater than 21 mm Hg and/or IOP-reducing surgery or devastating complication.
At the time of implantation of a second device, patients’ average age was 9.2 years. Mean IOP was 30 mm Hg, and patients were given an average of three IOP-lowering medications. Among the second devices implanted, 14 were placed in the same location as the first, and 29 were placed at a second location.
The researchers documented fibrovascular ingrowth at the time of second implantation and found fibrovascular ingrowth in 12 of 43 eyes within mean time of 70 months after implantation. Fibrovascular ingrowth was found only in Ahmed devices and was considered the cause of device failure in the 12 eyes, according to the researchers.
Second glaucoma drainage devices failed in 18 eyes, with device failure occurring within a mean of 26.1 months. Using Kaplan-Meier survival analysis, the researchers determined that second glaucoma drainage devices had a success rate of 81%, 62% and 50% at 1 year, 2 years and 3 years, respectively.
Disclosure: The authors have no relevant financial disclosures.
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