Surgical Outcomes of Glaucoma Drainage Device (GDD) Implantation for Refractory Sturge Weber-Associated Childhood Glaucoma
Landon C. Meekins, MD; Sonali Talsania, MD; Sharon F. Freedman, MD
Duke Eye Center
Durham, North Carolina
Introduction: Refractory Sturge Weber-associated glaucoma (SWG) in children presents management challenges; glaucoma drainage device (GDD) implantation has met with variable success [1-3]. Purpose: To evaluate GDD implantation for refractory pediatric SWG.
Methods: This retrospective, single-center study included consecutive GDD implantation for refractory SWG from 1994 to 2017 with >/=6mos follow-up. Failure occurred when IOP was clinically insufficient for glaucoma status, or additional intraocular pressure (IOP)-lowering surgery or devastating complication occurred. Primary outcome was surgical success (Kaplan-Meier survival) at 1-, 3-, and 5-years post-GDD.
Results: Thirty-two eyes met inclusion criteria, and had either Ahmed or Baerveldt GDDs. Mean preoperative IOP was 32.2±7.9 mmHg on 3.6±0.8 glaucoma medications. Mean postoperative IOP was significantly lower on significantly fewer glaucoma medications at one, three and five years postoperatively (POY1: 18.0±5.6 mmHg, 1.9±1.1 medications, p <0.00001; POY3: 19.8±8.4 mm Hg, 1.8±1.1 medications, p<0.001; POY5: 17.6±2.2 mm Hg, 2.5±1.2 medications, p< 0.01). Mean IOP reduction was 39.9%, 34.7% and 48.7% at postoperative years one, three and five, respectively. Surgical success [95% confidence interval] at 1-, 3-, and 5-years post-GDD was: 89.1% [96,70], 71.3% [85, 49], and 54.9% [73, 32], respectively. Failure occurred in 11 eyes (34%) by 5-years post-GDD: 6 eyes required additional IOP-reducing surgery, 1 had chronic hypotony, 3 required GDD tube explantation (1 with blebitis), 1 had cilioretinal artery occlusion immediately post-GDD (final vision 20/80).
Discussion: See Conclusion.
Conclusion: GDD implantation offers a reasonable approach to management of refractory childhood SWG, despite modest success at 5 years and some complications.
References: 1. Amini H, Razeghinejad MR, Esfandiarpour B. Primary single-plate Molteno tube implantation for management of glaucoma in children with Sturge-Weber syndrome. Int Ophthalmol. 2007 Dec;27(6):345-50. Epub 2007 Jun 8.
2. Hamush NG, Coleman AL, Wilson MR. Ahmed glaucoma valve implant for management of glaucoma in Sturge-Weber syndrome. Am J Ophthalmol 1999;128:758-60.
3. Wu SC, Lin KK. Ahmed glaucoma valve implant for childhood glaucoma in Sturge-Weber syndrome with choroidal hemangioma. Chang Gung Med J. 2006 Sep-Oct;29(5):528-31.