TY - JOUR
T1 - Pars plana Baerveldt implantation for refractory childhood glaucomas
AU - Banitt, Michael R.
AU - Sidoti, Paul A.
AU - Gentile, Ronald C.
AU - Tello, Celso
AU - Liebmann, Jeffrey M.
AU - Rodriguez, Natalia
AU - Dhar, Sonya
PY - 2009/6
Y1 - 2009/6
N2 - Purpose: To evaluate the effectiveness and associated complications of Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion in aphakic and pseudophakic children. Patients and Methods: The medical records of 30 patients (30 eyes) younger than 18 years old with uncontrolled glaucoma associated with aphakia or pseudophakia who underwent pars plana BGI surgery were retrospectively reviewed. Clinical outcome assessment included the measurement of intraocular pressure (IOP) and visual acuity and the identification of complications. Success was defined as 5 mm Hg < final postoperative IOP ≤21 mm Hg with or without glaucoma medications and without visually devastating complications or further glaucoma surgery. Outcomes were evaluated using Kaplan-Meier life-table analysis. Results: Mean follow-up after BGI surgery was 29.8 ± 26.4 months. Twelve, 24, and 36-month life-table rates for successful IOP control were 85%, 81%, and 72%, respectively. Six of 30 patients were considered failures. Complications included hypotony (5 patients, with 1 developing hemorrhagic choroidals which required surgical intervention and a second progressing to phthisis), retinal detachment (4 patients), tube obstruction (2 patients), pupillary membrane (1 patient), worsening esotropia (1 patient), focal scleral ectasia (1 patient), and loss of light perception (1 patient). Visually devastating complications were observed in 3 patients (hemorrhagic choroidals 1 patient, phthisis 1 patient, loss of light perception 1 patient). Conclusions: BGI surgery with pars plana tube insertion is a reasonable option for managing aphakic and pseudophakic children with uncontrolled glaucoma. Complications of BGI surgery related to anterior chamber tube placement, such as tubecornea touch, are minimized with this approach. The incidence of posterior segment complications, although possibly higher compared with limbal tube insertion, was not excessive.
AB - Purpose: To evaluate the effectiveness and associated complications of Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion in aphakic and pseudophakic children. Patients and Methods: The medical records of 30 patients (30 eyes) younger than 18 years old with uncontrolled glaucoma associated with aphakia or pseudophakia who underwent pars plana BGI surgery were retrospectively reviewed. Clinical outcome assessment included the measurement of intraocular pressure (IOP) and visual acuity and the identification of complications. Success was defined as 5 mm Hg < final postoperative IOP ≤21 mm Hg with or without glaucoma medications and without visually devastating complications or further glaucoma surgery. Outcomes were evaluated using Kaplan-Meier life-table analysis. Results: Mean follow-up after BGI surgery was 29.8 ± 26.4 months. Twelve, 24, and 36-month life-table rates for successful IOP control were 85%, 81%, and 72%, respectively. Six of 30 patients were considered failures. Complications included hypotony (5 patients, with 1 developing hemorrhagic choroidals which required surgical intervention and a second progressing to phthisis), retinal detachment (4 patients), tube obstruction (2 patients), pupillary membrane (1 patient), worsening esotropia (1 patient), focal scleral ectasia (1 patient), and loss of light perception (1 patient). Visually devastating complications were observed in 3 patients (hemorrhagic choroidals 1 patient, phthisis 1 patient, loss of light perception 1 patient). Conclusions: BGI surgery with pars plana tube insertion is a reasonable option for managing aphakic and pseudophakic children with uncontrolled glaucoma. Complications of BGI surgery related to anterior chamber tube placement, such as tubecornea touch, are minimized with this approach. The incidence of posterior segment complications, although possibly higher compared with limbal tube insertion, was not excessive.
KW - Glaucoma implant device
KW - Pars plana tube insertion
KW - Pediatric glaucoma
UR - http://www.scopus.com/inward/record.url?scp=68249113757&partnerID=8YFLogxK
U2 - 10.1097/IJG.0b013e31818624bd
DO - 10.1097/IJG.0b013e31818624bd
M3 - Article
C2 - 19525734
AN - SCOPUS:68249113757
SN - 1057-0829
VL - 18
SP - 412
EP - 417
JO - Journal of Glaucoma
JF - Journal of Glaucoma
IS - 5
ER -