Poster 193

by in  Poster Session 3

Techniques and Outcomes of Strabismus Surgery in the Setting of Glaucoma Drainage Devices in the Pediatric Population

Andrew R. Lee, MD; Sonali D. Talsania, MD; Sharon F. Freedman, MD
Duke University Department of Ophthalmology
Durham, North Carolina


Introduction: Glaucoma drainage devices can worsen strabismus in adults[1,2] and children[3], presenting surgical challenges. Purpose: to evaluate techniques and outcomes of strabismus surgery concomitant with, or following glaucoma drainage device(GDD) implantation for refractory childhood glaucoma.

Methods: Review of strabismus surgery performed concomitant with, or following GDD implantation for childhood glaucoma (ages 0-21yrs), with a single attending, 12/2005-6/2016. Included were surgeries with motility/alignment data pre-operatively and ≥3mos post-operatively. Data collected included: demographics, vision, glaucoma diagnosis, GDD type/location, pre-/post-operative sensorimotor/alignment measurements, and strabismus surgery details.

Results: Twenty-five patients met criteria. Mean age at strabismus surgery was 9.1±4.6yrs. GDDs included: Ahmed FP7/S2(n=13,52%), Baerveldt 250mm2(8,32%), Baerveldt 350mm2(4,16%). Glaucoma diagnoses included: following cataract surgery(GFCS,10/25,40%), primary congenital(PCG,6/25,24%), other(9/25,36%). Only 1/25(4%) had pre-operative diplopia.
Of 15 strabismus surgeries concomitant with GDD, 13(86.7%) were lateral rectus recession for exotropia. Pre-operative motility restriction and/or intraoperative scarring occurred in 4/15(26.7%). Mean pre-operative deviation (27±9.7 prism diopters(PD)) decreased by mean 40.4% post-operatively, with improved alignment in 11/15(73.3%). Techniques included hangback(12,80%) and GDD plate trimming(4,26.7%).
Of 10 strabismus surgeries following GDD, deviations included exotropia(4,40%), esotropia(3,30%), and multiple/other(3,30%). The most common procedure was two-muscle recession/resection(6,60%), with peri-GDD capsule dissection in 8/10(80%). All cases had pre-operative motility restriction and/or intraoperative scarring. Mean pre-operative deviation (27+/-14.6PD) decreased by 43.0% post-operatively, with improved alignment in 7/10(70%).
There were no surgical complications(0/25).

Discussion: Strabismus surgery for children with existing/planned GDDs requires techniques tailored to their poor binocularity, motility restriction, scarring, and muscle-GDD plate/capsule proximity.

Conclusion: Strabismus surgery involving GDDs, while challenging, can safely and substantially improve alignment in refractory childhood glaucoma, whether performed concomitant with, or subsequent to, GDD placement.

References: [1] Osigian CJ, Cavuoto KM, Rossetto JD, Sayed M, Grace S, Chang TC, et al. Strabismus surgery outcomes in eyes with glaucoma drainage devices. Journal of American Association for Pediatric Ophthalmology and Strabismus {JAAPOS}.21:103-6.e2.
[2] Roizen A, Ela-Dalman N, Velez FG, Coleman AL, Rosenbaum AL. Surgical treatment of strabismus secondary to glaucoma drainage device. Archives of Ophthalmology. 2008;126:480-6.
[3] Talsania SD LA, Freedman SF. Strabismus Following Glaucoma Drainage Device Implantation for Refractory Childhood Glaucoma: Incidence and Risk Factors. Poster presentation at: American Association for Pediatric Ophthalmology and Strabismus 43rd Annual Meeting. 2017. Manuscript submitted to JAAPOS.

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