Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series.

PURPOSE: We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery.

METHODS

Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure </=22 mm Hg, or judged adequate for glaucoma severity, without vision loss or devastating complication.

RESULTS

The study included 9 eyes of 8 children who had a mean age of 7.6 years (range, 1-16) and a mean follow-up time of 21 months (range, 8.5-35 months) after simultaneous IOL (either cataract removal with primary IOL, 2 eyes; or secondary IOL implantation, 7 eyes), and glaucoma implant surgery (6 Baerveldt, 3 Ahmed). The indications for combined surgery fell into 3 basic categories: unilateral aphakia with glaucoma (4/9), anatomical features (such as shallow anterior chamber and/or vitreous in the pupillary plane) making an IOL helpful in positioning the tube away from corneal endothelium and/or vitreous (4/9), and unilateral traumatic cataract (1/9). Mean intraocular pressure for operated eyes was 29 mm Hg (range, 21-44) preoperatively and fell to 17 mm Hg (range, 11-22) at last follow up, P = 0.01. The mean number of glaucoma medications was 3.5 preoperatively (range, 2-5) versus 1.9 (range, 0-4) at last follow-up (p = NS). Complications (n = 5) were varied, only 2 of which required additional surgery. Eighty-nine percent (8/9) of patients met criteria for success at last follow-up.

CONCLUSIONS

Selected children can do well after combined glaucoma implant and IOL surgery, achieving both satisfactory glaucoma control and stable visual acuity.