Aqueous drainage device surgery in refractory pediatric glaucomas: I. Long-term outcomes.
PURPOSE: To determine the long-term outcomes and complications of aqueous drainage device surgery in children with congenital and aphakic glaucoma. METHODS: Chart review of consecutive children treated with aqueous drainage device surgery at Duke University Eye Center from 1995 to 2006, recording demographic, glaucoma-related, and anterior segment examination findings. RESULTS: Included are 30 children (38 eyes) with congenital glaucoma and 32 children (41 eyes) with aphakic glaucoma. Median follow-up was 5.5 years (0.5-10.5) in the congenital glaucoma group and 3.5 years (0.5-13.8) in the aphakic glaucoma group. Pre-aqueous drainage device median intraocular pressure (IOP) was 29 mmHg in the congenital glaucoma group and 36 mmHg in the aphakic glaucoma group. Post-aqueous drainage device median IOP was 14 and 15 mmHg in the congenital and aphakic glaucoma group, respectively (p < 0.0001 vs pre-aqueous drainage device IOP). Post-aqueous drainage device pupil abnormalities were noted in 16% and 7% of eyes in the congenital glaucoma and aphakic glaucoma groups, respectively, and cataract occurred in 20% of phakic eyes in the congenital glaucoma group. Reoperation was necessary in 26% and 22% of eyes in the congenital glaucoma and aphakic glaucoma groups, respectively. One-year Kaplan-Meier success was 92% and 90% in the congenital and aphakic glaucoma groups, respectively, but fell by 10 years to 42% and 55%, respectively. Vision-threatening complications occurred in 10% of eyes overall. DISCUSSION: Aqueous drainage device surgery is moderately successful in children with refractory congenital and aphakic glaucoma. Common complications include corneal touch and cataract; iris abnormalities occur less commonly.
O'Malley Schotthoefer, E; Yanovitch, TL; Freedman, SF
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