Paper 16

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The Ahmed-Baerveldt Comparison (ABC) Study for Pediatric Refractory Glaucoma

Bibiana J. Reiser; Yohko Murakami; Ja-Yoon Choe; Dilshad Contractor; Mark Reid
Children’s Hospital Los Angeles
Los Angeles

Introduction:  Aqueous drainage devices have proven efficacious in adult glaucoma management, but their efficacy in pediatric glaucoma is unclear. In this study, post-operative outcomes from implantation of Ahmed FP7 valves (AGV) and Baerveldt 350 glaucoma implants (BGI) in a heterogeneous group of pediatric refractory glaucoma patients at a tertiary referral center were compared.

Methods:  Patient charts detailing AGV or BGI implant surgeries between 2007-2013 were reviewed retrospectively. Valve failure rates over time were compared using Kaplan-Meier survival estimates. Cox proportional hazard modeling was used to examine effects of disease type, medications, patient age and sex on valve failure.

Results:  Successful postoperative IOP control was observed in 22/41 AGV (54%), and 34/48 BGI (71%). After 12 months, 20% of AGV and 2% of BGI implants failed; after 5 years, over 80% of AGV failed, compared to 50% of BGI. Increased medication use preoperatively was associated with more frequent failure (HR = 1.54, 95% CI = 1.11-2.15). Failure was seen less frequently in secondary glaucoma cases (HR = 0.33, 95% CI = 0.13-0.83) . Patient age and sex were not significantly related to failure.

Discussion:  Both AGV and BGI devices achieved some surgical success in lowering intraocular pressure (IOP) postoperatively; however, BGI implants showed greater, more sustained IOP reduction over time, with lower rates of failure and postsurgical complications.

Conclusion:  Aqueous drainage devices are efficacious surgical options for IOP control of pediatric refractory glaucomas. Patients’ history, disease type and long-term needs should be carefully considered before selecting an appropriate drainage device.

References:
1. Patel S, Pasquale LR. Glaucoma drainage devices: A review of the past, present, and future. Semin Ophthalmol. 2010;25(5-6):265-270. http://dx.doi.org/10.3109/08820538.2010.518840. doi: 10.3109/08820538.2010.518840.
2. Morad Y, Donaldson CE, Kim YM, Abdolell M, Levin AV. The Ahmed drainage implant in the treatment of pediatric glaucoma. Am J Ophthalmol. 2003;135(6):821-829. doi: http://dx.doi.org/10.1016/S0002-9394(02)02274-2.
3. Budenz DL, Gedde SJ, Brandt JD, Kira D, Feuer W, Larson E. Baerveldt glaucoma implant in the management of refractory childhood glaucomas. Ophthalmology. 2004;111(12):2204-2210. doi: https://doi.org/10.1016/j.ophtha.2004.05.017.

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