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 ≥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.