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Abstract #81973 Published in IGR 20-4

Home Tonometry Assists Glaucoma Drainage Device Management in Childhood Glaucoma

Go MS; Barman NR; House RJ; Freedman SF
Journal of Glaucoma 2019; 28: 818-822

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: PRéCIS: Home tonometry is useful in detecting tube-opening and alarming intraocular pressures (IOPs) after Baerveldt glaucoma drainage device (GDD) implantation in childhood glaucoma, allowing for timely physician response and individualized patient care. PURPOSE: The postoperative management of the nonvalved Baerveldt GDD presents challenges in pediatric patients due to widely variable IOP often occurring perioperatively. We evaluated the use of home tonometry in the management of Baerveldt implants for refractory childhood glaucoma. MATERIALS AND METHODS: As part of an ongoing prospective study involving home rebound tonometry, the families of patients receiving Baerveldt implants were trained to use the Icare TA01i rebound tonometer and asked to document IOP, relevant symptoms, and ocular medication changes outside of the clinic setting. Data were analyzed for time to tube-opening, multiple-day fluctuations, and various IOP trends. Clinician response to IOP fluctuations detected by home tonometry was also evaluated. RESULTS: Included were 19 patients (mean age: 16.1±9.6 y) having Baerveldt implantation from 2015 to 2018 by 1 attending physician. Home tonometry detected 92.3% (12/13) of spontaneous tube-openings, which occurred at a mean of 6.0±0.5 weeks. By home tonometry, mean IOP decreased 32.7% (24 vs. 15 mm Hg, P<0.01); 5-day IOP fluctuation decreased from 15 mm Hg preoperatively to 8 mm Hg after tube-opening (P<0.05). Preoperative, postimplantation, and post-tube-opening IOP ranged from 10 to 59, 3 to 61, and 1 to 51 mm Hg, respectively. Home tonometry prompted 94 documented medication changes and validated 1 surgical decision among 14 patients. CONCLUSIONS: Home rebound tonometry accurately detected tube-opening and alarming IOP fluctuations, allowing clinicians to promptly and appropriately respond to these events. Home tonometry-augmented GDD management in childhood glaucoma may improve the care of these challenging patients.

Department of Ophthalmology, Duke University Medical Center, Durham, NC.

Full article

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Classification:

9.1.2 Juvenile glaucoma (Part of: 9 Clinical forms of glaucomas > 9.1 Developmental glaucomas)
6.1.1 Devices, techniques (Part of: 6 Clinical examination methods > 6.1 Intraocular pressure measurement; factors affecting IOP)
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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