GLAUCOMA

Paediatric patients do well with glaucoma drainage implants (GDI) in the long-term, according to findings from a new study, but a relatively high rate of complications should be expected. “Close monitoring and active management of complications are of paramount importance to ensure successful paediatric GDI surgery," according to Achilleas Mandalos MD, Birmingham and Midland Eye Centre in Birmingham, UK. GDIs are generally reserved for paediatric glaucoma cases that respond poorly to goniotomy or trabeculectomy. Their use in this population has been on the increase in the last decade, however, long-term outcomes and safety from the implants in this age group has not been fully determined.

GDI surgery A retrospective study of all paediatric patients less than 18 years of age who underwent GDI by the same surgeon (Velota Sung, MD), between 2004 to 2011, was performed. Successful outcome was defined as IOP between 6 and 22 mmHg (with or without medication), and at least 20 per cent reduction in IOP from the surgery, no devastating vision loss and no need for further glaucoma surgery according to details in a poster presented by the researchers at the 5th World Glaucoma Congress. The study included 52 patients (half were female) who underwent 69 GDI procedures. Close to 32 per cent had aphakic glaucoma, about 22 per cent had congenital glaucoma and 20 per cent had uveitic glaucoma. A total of 55 per cent were given the Baerveldt-250 implant, while the remainder had either the Molteno or Baerveldt-350 implants. Mean follow-up was 45.7 months, ranging from three to 101 months.

“The data were collected at the last preoperative visit and at three months, one year and six monthly visits up to the last clinic visit,” he said. At the start of the study, success was defined as a postoperative IOP between 6 and 22 mmHg with or without medication, and a drop in IOP of at least 20 per cent after surgery, according to details in the poster. Researchers found that at the last clinic visit, overall success was attained in 66.6 per cent of cases, with 49.3 per cent being defined as a complete success. Within the first six months after surgery, 39.1 per cent had developed hypotony, 21.7 per cent had choroidal effusion, 20.5 per cent of phakic patients had cataracts and a small number, 2.9 per cent, developed endophthalmitis. Six months or more after surgery, 13.4 per cent had hypotony, 5.9 per cent had choroidal effusion, 22.9 per cent of phakic patients had cataracts. Endophthalmitis occurred in 5.8 per cent of patients. Close monitoring Overall, the outcomes in this group compared favourably to those in other studies in the medical literature. But because of the relatively high rate of complications in this age group, "close monitoring and active management of complications are of paramount importance to ensure success of paediatric GDI surgery," Mr Mandalos told EuroTimes.