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Glaucoma drainage devices (GDD), which have aided adult eyes, may also help manage refractory glaucoma in pediatric patients. An Ophthalmology Glaucoma case series shows that implanting the Ahmed glaucoma valve (AGV), a GDD, provided long-term success and graft survival to eyes of pediatric patients who have undergone penetrating keratoplasty and have glaucoma. They published their results in.
This is the largest case series to evaluate outcomes of AGV implantation in eyes with pediatric keratoplasty.
The researchers reviewed medical records of 25 pediatric patients (28 eyes) aged less than 16 years who underwent AGV implantation post-keratoplasty for uncontrolled glaucoma. Primary congenital glaucoma was present in 13 eyes. Aniridia was present in 6 eyes, and corneal scar was present in 6 eyes. Twenty-two eyes had undergone penetrating keratoplasty, and 6 had undergone Descemet’s stripping endothelial keratoplasty (DSEK). Each had at least 6 months follow-up. The investigators excluded 2 eyes that had graft failures prior to AGV implantations.
The mean age at the time of AGV was 4.8±0.7 years, with a mean duration from corneal procedure to AGV of 20.52±3.24 months.
The investigators found that the probability of success of AGV was 96.2%±3.8% (number at risk=26), 84.3%±7.2% at 2 years (n=20) and 3 years (n=16), 77.8%±9.1% (n=13) at 4 years. The probability of success remained the same until 8 years (n=6). Keratoplasty failed in 5 eyes. Two eyes had post graft infection failure and 3 experienced graft failure.
Mean intraocular pressure (IOP) decreased from 31.5±2.0 mm Hg to 21.1±2.3 mm Hg at 6 months post-surgery (P <.001). The mean number of anti-glaucoma medications (AGM) decreased significantly, from 3.2±0.2 to 1.8±0.2 (P <.0001).
The postoperative mean logMAR visual acuity at the final visit was 1.46±0.22. Mean change in visual acuity between preoperative and month 1 was 0.52±0.2 and 0.40±0.32 at 6 months. Mean change in visual acuity between month 6 and month 1 was -0.13±0.08.
Graft infection (n=8) was the most common serious complication. Conservative treatment for the infection resulted in either corneal scarring (6 eyes) or graft failure (2 eyes). The most common organism associated with graft infiltrates was Streptococcus Pneumoniae.
AGV as a primary procedure was not associated with improved device survival compared with its use as a second or third procedure (P =.98). Researchers noted no significant differences in AGV success (P =.73) or graft survival (P =.18) between eyes that underwent PK compared with eyes that underwent DSEK.
Limitations of the study included the fact that it was retrospective and had a variable follow-up and lacked a comparison group.
Reference
Senthil S, Rai M, Mohamed A, et al. Outcomes of Ahmed glaucoma valve implantation in eyes with pediatric keratoplasty. Ophthalmol Glaucoma. Published July 6, 2021.
doi:10.1016/j.ogla.2021.07.001.
