Baerveldt glaucoma implant in the management of refractory childhood glaucomas

Abstract

Purpose: To evaluate the effectiveness and safety of the Baerveldt glaucoma drainage implant (GDI) in the management of pediatric glaucomas.

Design: Retrospective noncomparative case series.

Participants: Sixty-two children younger than 18 years who underwent Baerveldt GDI surgery.

Main outcome measures: Intraocular pressure (IOP), intraoperative and postoperative complications, number of glaucoma medications, and VA. Success was defined as IOP of <22 mmHg and > or =5 mmHg with or without medications, no loss of light perception, and no further surgical intervention for glaucoma. Outcomes were compared for patients with primary and secondary glaucomas.

Results: Sixty-two eyes of 62 patients were identified. The mean patient age (+/- standard deviation) at time of Baerveldt glaucoma implant surgery was 6.5+/-5.6 years (range, 6 weeks-17 years). With an average follow-up of 23.4+/-21.7 months (range, 1-106), IOP was reduced from a mean of 35.0+/-8.7 mmHg (range, 17-54) preoperatively to 17.6+/-8.4 mmHg (range, 5-45) at last follow-up visit (P<0.001). Kaplan-Meier survival analysis showed a cumulative success of 85% at 6 months, 80% at 12 months, 67% at 24 months, and 60% in months 28 through 106. There was no difference between primary (N = 23) and secondary glaucoma (N = 39) patients in terms of length of follow-up, final IOP, number of medications, or cumulative success (P = 0.21).

Conclusion: Baerveldt glaucoma implant surgery seems to be an effective treatment for primary and secondary refractory glaucomas in children. There is a risk of retinal detachment that may be related to the implant or other ocular conditions.