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Abstract #9972 Published in IGR 5-3
Aqueous shunt devices compared with trabeculectomy with mitomycin-C for children in the first two years of life
Beck AD; Freedman S; Kammer J; Jin JAmerican Journal of Ophthalmology 2003; 136: 994-1000
PURPOSE: To compare the outcomes of children 24 months of age or younger treated with aqueous shunt devices or with mitomycin-C (MMC) trabeculectomy. DESIGN: Retrospective, age-matched, comparative case series. METHODS: Forty-six eyes of 32 patients with mean age of 7.0 ± 5.1 month (range, 1-22 months) and uncontrolled glaucoma, which received an aqueous shunt device (Ahmed glaucoma valve or Baerveldt implant), compared with 24 eyes of 19 patients with mean age of 5.3 ± 4.8 months (range, 0.5-24 months), which received an MMC trabeculectomy. Surgical success was defined as intraocular pressure < 23 mmHg on maximal glaucoma medication, no further glaucoma surgery performed or recommended, no devastating complication, and stable ocular dimensions (axial length and corneal diameter). RESULTS: Cumulative probabilities of success were 87 ± 5.0% for the aqueous shunt group compared with 36 ± 8.0% success in the trabeculectomy group at 12 months and 53 ± 12% in the aqueous shunt group compared with 19 ± 7% in the trabeculectomy group at 72 months (Χ2 of 23.5, p < 0.0001). Aqueous shunt implantation was associated with significantly more postoperative complications requiring a return to the operating room (21 of 46 eyes, 45.7%) compared with trabeculectomy with MMC (three of 24 eyes, 12.5%, p = 0.0074). The most common postoperative procedure in the aqueous shunt group was tube repositioning, performed in 16 of 46 eyes (34.8%). CONCLUSIONS: Aqueous shunt implantation offers a significantly greater chance of successful glaucoma control in the first two years of life, compared to trabeculectomy with MMC. However, the enhanced success with aqueous shunt devices is associated with a higher likelihood of postoperative complications requiring surgical revision, most commonly tube repositioning.
Dr. A.D. Beck, Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30322, USA. abeck@emory.edu
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.8.10 Woundhealing antifibrosis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)