Aqueous drainage device surgery in refractory pediatric glaucomas: I. Long-term outcomes.

PURPOSE: To determine the long-term outcomes and complications of aqueous drainage device surgery in children with congenital and aphakic glaucoma.

METHODS

Chart review of consecutive children treated with aqueous drainage device surgery at Duke University Eye Center from 1995 to 2006, recording demographic, glaucoma-related, and anterior segment examination findings.

RESULTS

Included are 30 children (38 eyes) with congenital glaucoma and 32 children (41 eyes) with aphakic glaucoma. Median follow-up was 5.5 years (0.5-10.5) in the congenital glaucoma group and 3.5 years (0.5-13.8) in the aphakic glaucoma group. Pre-aqueous drainage device median intraocular pressure (IOP) was 29 mmHg in the congenital glaucoma group and 36 mmHg in the aphakic glaucoma group. Post-aqueous drainage device median IOP was 14 and 15 mmHg in the congenital and aphakic glaucoma group, respectively (p < 0.0001 vs pre-aqueous drainage device IOP). Post-aqueous drainage device pupil abnormalities were noted in 16% and 7% of eyes in the congenital glaucoma and aphakic glaucoma groups, respectively, and cataract occurred in 20% of phakic eyes in the congenital glaucoma group. Reoperation was necessary in 26% and 22% of eyes in the congenital glaucoma and aphakic glaucoma groups, respectively. One-year Kaplan-Meier success was 92% and 90% in the congenital and aphakic glaucoma groups, respectively, but fell by 10 years to 42% and 55%, respectively. Vision-threatening complications occurred in 10% of eyes overall.

DISCUSSION: Aqueous drainage device surgery is moderately successful in children with refractory congenital and aphakic glaucoma. Common complications include corneal touch and cataract; iris abnormalities occur less commonly.