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Editors Selection IGR 23-1
Surgical Treatment: Drainage Devices in Pediatric Glaucoma
Comment by Jose-Maria Martinez de la Casa on:
61370 Valved Glaucoma Drainage Devices in Pediatric Glaucoma: Retrospective Long-term Outcomes, Chen A; Yu F; Law SK et al., JAMA ophthalmology, 2015; 133: 1030-1035
In this paper, Chen et al. present a retrospective study about 119 eyes of 89 patients with pediatric glaucoma who underwent Ahmed glaucoma valve (AGV) implantation. Mean age at time of implantation was 6.8 ± 5.7 years and mean follow-up was 6.1 ± 3.3 years (range 1 to 14.2 years).
Mean IOP decrease was 13.0 mmHg (95%CI, 8.8 to 17.3 mmHg) at five years postoperatively without significant differences in hypotensive medications requirements compared to baseline. The success rates for all eyes were 85.7% (95% CI, 79.7%- 92.2%) at one year and 36.8% (95%CI, 26.8%-50.4%) at ten years. The success rate at five years was 41.8% (95%CI, 26.5%-66.0%) for eyes with primary glaucoma, 75.0% (95% CI, 57.7%-97.5%) for uveitic eyes, and 53.9% (95% CI, 41.8%-69.4%) for eyes with other secondary glaucoma. There were no significant differences between groups. Surprisingly, unlike previous studies,1,2 five years survival rate was significantly higher with polypropylene (S-2) implants than with silicone ones (FP-7) 66.9% vs 41.2% (p < 0.001).
Risk factor analysis showed that older age (risk ratio = 0.95; 95%CI, 0.90-0.99; P = .02), uveitic glaucoma (risk ratio = 0.34; 95% CI, 0.14-0.86; P = .02), and polypropylene AGVs (risk ratio = 0.39; 95%CI, 0.23-0.67; P = .001) were associated with higher success rates. Tube revision (21.8%), cataract progression requiring cataract surgery (4.2%) and strabismus surgery (2.5%) were the most frequent complications during the follow up. Complications were not associated with diagnosis or AGV model. Thirty six eyes (30.2%) received a second AGV. The success rate for this second implant was 52.8% (95%CI, 37.0%-75.3%) at 5years.
In summary, with the limitations of a retrospective study, the authors have collected information on an important case series of pediatric glaucoma that will help in the management of this complex pathology
References
- Khan AO, Al-Mobarak F. Comparison of polypropylene and silicone Ahmed valve survival 2 years following implantation in the first 2 years of life. Br J Ophthalmol 2009;93(6):791-794.
- El Sayed Y, Awadein A. Polypropylene vs silicone Ahmed valve with adjunctive mitomycin C in paediatric age group: a prospective controlled study. Eye (Lond) 2013;27(6):728-734.
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