Glaucoma Drainage Device Surgery Outcomes in Children With Uveitic Glaucoma

Evangelia Gkaragkani; Hari Jayaram; Maria Papadopoulos; Carlos Pavesio; John Brookes; Peng T Khaw; Yasmine M El Sayed; Jonathan Clarke

doi:10.1016/j.ajo.2023.02.004

Glaucoma Drainage Device Surgery Outcomes in Children With Uveitic Glaucoma

Am J Ophthalmol. 2023 Jul:251:5-11. doi: 10.1016/j.ajo.2023.02.004. Epub 2023 Feb 22.

Authors

Evangelia Gkaragkani¹, Hari Jayaram², Maria Papadopoulos¹, Carlos Pavesio², John Brookes², Peng T Khaw², Yasmine M El Sayed¹, Jonathan Clarke³

Affiliations

¹ Moorfields Eye Hospital (E.G., H.J., M.P., C.P., J.B., P.T.K., Y.M.E.S., J.C.).
² Moorfields Eye Hospital (E.G., H.J., M.P., C.P., J.B., P.T.K., Y.M.E.S., J.C.); NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom (H.J., C.P., J.B., P.T.K., J.C.).
³ Moorfields Eye Hospital (E.G., H.J., M.P., C.P., J.B., P.T.K., Y.M.E.S., J.C.); NIHR Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom (H.J., C.P., J.B., P.T.K., J.C.). Electronic address: jonathan.clarke8@nhs.net.

PMID: 36822573
DOI: 10.1016/j.ajo.2023.02.004

Abstract

Purpose: To evaluate outcomes of glaucoma drainage device (GDD) implantation children with uveitic glaucoma.

Design: Retrospective interventional case series.

Methods: Success was defined as intraocular pressure (IOP) ≥5 and ≤21 mm Hg. Failure was defined at final follow-up when the IOP was outside the success criterion, and visual function was no perception of light or if further glaucoma surgery (excluding removal of intraluminal stent suture or needling) was required.

Results: Fifty eyes of 36 children with uveitic glaucoma underwent GDD implantation. Mean age at surgery was 10.1±3.1 years (range 5-17) with a mean follow-up of 113±61 months (range 8-228). Mean cumulative probabilities of success (95% CI) were 0.98 (0.86-1.00) at 1 year, 0.87 (0.73-0.94) at 5 years, and 0.59 (0.32-0.78) at 15 years. Fourteen tubes were classified as failed, with 12 due to uncontrolled IOP (11 eyes required a second GDD); 1 eye, removal of the tube due to plate exposure; and 1 eye, lost light perception. Postoperative complications occurred in 36% of patients and included hypotony (22%), tube exposure (6%), tube obstruction (4%), corneal decompensation (2%), and cystoid macular edema (2%). Visual acuity remained stable (preoperation 0.35±0.42 vs postoperation 0.45±0.67, P = .49). IOP was significantly reduced from 31.4±7.5 mm Hg to 14.4±5.1 mm Hg (P < .0001) as were the number of glaucoma medications 3.5±1.0 vs 1.1±1.3 (P < .0001).

Conclusions: Refractory pediatric uveitic glaucoma can be treated successfully by GDD implantation. Further interventions to manage consequences of glaucoma or the underlying disease are common, and visual function is maintained in the majority of cases.

MeSH terms

Child
Follow-Up Studies
Glaucoma Drainage Implants* / adverse effects
Glaucoma*
Humans
Infant
Intraocular Pressure
Prosthesis Implantation / adverse effects
Retrospective Studies
Treatment Outcome