The shrinking eye: dimensional changes in the young child's eye after glaucoma drainage device implantation for refractory childhood glaucoma.

PURPOSE: To investigate the magnitude of reduction in the axial length (AL) and corneal diameter following glaucoma drainage device (GDD) placement and intraocular pressure (IOP) reduction in glaucoma patients <3 years of age at surgery. METHOD: The medical records of consecutive childhood glaucoma patients who underwent GDD implantation at a single practice between 2013 and 2018 and were <3 years of age at surgery were reviewed retrospectively. Demographics, glaucoma diagnoses, surgical details, and pre- and post-procedure measurements of AL, IOP, corneal diameter, central corneal thickness, presence of corneal edema, and cup:disk ratio were analyzed. RESULTS: A total of 16 eyes of 10 patients were included. Before GDD placement, mean AL was 23.49 ± 3.05 mm. Mean AL reduction after placement was 0.80 ± 0.85 mm (P = 0.001); median AL reduction, 0.93 mm (range, -3.05 to +0.59). Mean IOP reduction after GDD placement was 15.0 ± 6.0 mm Hg (P < 0.0001). IOP reduction and AL reduction were significantly related (P = 0.0013). Mean corneal diameter before GDD placement was 13.0 ± 1.6 mm; mean corneal diameter reduction after placement was 0.3 ± 0.3 mm (P = 0.012). Reduction of corneal diameter and of AL were significantly related (P = 0.03); corneal diameter and IOP were not (P = 0.40). Objective cupping reversal after GDD was noted in 50% of eyes with documented cup:disk ratio. CONCLUSIONS: In this study cohort, reduction in AL, corneal diameter, and cup:disk ratio was found to be correlated with reduced IOP after GDD placement. This result merits consideration during surgical planning for glaucoma patients <3 years of age.

Duke Scholars

Author Sharon Fridovich Freedman Ophthalmology