Home > News > The Role of Glaucoma Drainage Devices in Paediatric Glaucoma
Glaucoma, Paediatric Ophthalmology
Read Time: 1 min

The Role of Glaucoma Drainage Devices in Paediatric Glaucoma

Published Online: August 5th 2012 European Ophthalmic Review, 2012;6(4):208-213 DOI: http://doi.org/10.17925/EOR.2012.06.04.208
Authors: Esperanza Gutiérrez-Díaz, Enrique Mencía-Gutiérrez, Pilar Tejada-Palacios
Quick Links:
Abstract
Article
Article Information
Abstract:
Overview

Glaucoma drainage devices may be indicated in glaucoma associated to complex congenital anomalies or dysgenesis of the anterior segment, secondary glaucomas such as those developed after congenital cataract surgery, severe primary congenital glaucoma after failed angle surgery and in eyes with severe conjunctival scarring. They can be combined with several other procedures, such as cataract extraction, intraocular lens implantation, keratoplasty or pars plana vitrectomy. This procedure may achieve a sustained and prolonged intraocular pressure reduction in children, with early post-operative success as high as 90 %, although it decreases over time, to 40–60 % survival at 4–6 years using the Kaplan-Meier analysis and most children need to reinitiate glaucoma treatment postoperatively. We must bear in mind that complications may occur, especially tube malposition and exposure, and multiple repeated surgeries may be necessary. The advantages and complications should be weighed in each individual case.

Keywords

Ahmed valve, complications, glaucoma drainage device (GDD), glaucoma, paediatric, surgery

Article:

The treatment of glaucoma in childhood is primarily surgical. The goniotomy is considered the procedure of choice in primary congenital glaucoma,1 but in secondary glaucoma and after failed angle surgery, other procedures should be considered. Among these the glaucoma drainage devices (GDD). The Molteno single-plate was the GDD used in children for the first time in 1973 by Molteno.2 Since then, numerous papers dealing with the results and complications of this procedure in children have been published,3–27 and nowadays, the effectiveness of GDD has been well-established. However, we must bear in mind the extremely long life expectancy of a paediatric patient, which will probably require the care of two or more generations of ophthalmologists throughout his life. For this reason, all the possible surgical options should be considered and caution should be taken when selecting the most adequate one, which may be a GDD or some other procedure.

Indications
GDD may be indicated in glaucoma associated to complex congenital anomalies or dysgenesis of the anterior segment, such as Peter’s syndrome or aniridia and secondary glaucomas such as those developed after congenital cataract surgery or in Sturge-Weber syndrome.3

Regarding primary congenital glaucoma, although goniotomy and trabeculotomy are undoubtedly the treatments of choice, in severe cases GDD may also be considered, as the prognosis following surgery is closely related to the severity of the glaucoma. Al-Hazmi et al.28 have shown how severe primary congenital glaucoma had worse results than moderate or mild cases, regardless of the surgical procedure performed, with trabeculotomy achieving a success rate of only 10 % after one year in severe cases, versus 40 and 90 % in moderate and mild cases, respectively. Severe conjunctival scarring is a clear indication for GDD surgery.3

To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Enrique Mencía-Gutiérrez, Ophthalmology Department, 12 de Octubre Hospital, E28041 Madrid, Spain. E: emencia.hdoc@salud.madrid.org

Received

2012-08-15T00:00:00

References

  1. Papadopoulos M, Khaw PT, Goniotomy and trabeculotomy. In: Shaarawy T, Sherwood MB, Hitchings RA, Crowston JG, Glaucoma vol. 2 Surgical management, Elsevier, 2009:493.
  2. Molteno ACB, Ancer E, Biljon GV, Children with advanced glaucoma treated by draining implants, S Afr J Ophthalmol, 1973;1:55–61.
  3. Ishida K, Mandal AK, Netland PA, Glaucoma drainage implants in pediatric patients, Ophthalmol Clin North Am, 2005;18:431-42.
  4. Beck AD, Freedman S, Kammer J, Jin J, Aqueous shunt devices compared with trabeculectomy with mitomycin-C for children in the first two years of life, Am J Ophthalmol, 2003;136:994–1000.
  5. Budenz DL, Gedde SJ, Brandt JD, et al., Baerveldt glaucoma implant in the management of refractory childhood glaucomas, Ophthalmology, 2004;111:2204–10.
  6. Rolim de Moura C, Fraser-Bell S, Stout A, et al., Experience with the baerveldt glaucoma implant in the management of pediatric glaucoma, Am J Ophthalmol, 2005;139:847–54.
  7. Tesser R, Hess DB, Freedman SF, Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series, J AAPOS, 2005;9:330–5.
  8. Autrata R, Helmanova I, Oslejskova H, et al., Glaucoma drainage implants in the treatment of refractory glaucoma in pediatric patients, Eur J Ophthalmol, 2007;17:928–37.
  9. Khan AO, Al-Mobarak F, Comparison of polypropylene and silicone Ahmed valve survival 2 years following implantation in the first 2 years of life, Br J Ophthalmol, 2009;93:791–4.
  10. Hill R, Ohanesian R, Voskanyan L, Malayan A, The Armenian Eye Care Project: surgical outcomes of complicated paediatric glaucoma, Br J Ophthalmol, 2003;87:673-6.
  11. Albis-Donado O, Gil-Carrasco F, Romero-Quijada R, Thomas R, Evaluation of Ahmed glaucoma valve implantation through a needle-generated scleral tunnel in Mexican children with glaucoma, Indian J Ophthalmol, 2010;8:365–73.
  12. Chen TC, Bhatia LS, Walton DS, Ahmed valve surgery for refractory pediatric glaucoma: a report of 52 eyes, J Pediatr Ophthalmol Strabismus, 2005;42:274–83.
  13. Al-Mobarak F, Khan AO, Complications and 2-year valve survival following Ahmed valve implantation during the first 2 years of life, Br J Ophthalmol, 2009;93:795–8.
  14. Ou Y, Yu F, Law SK, Coleman AL, Caprioli J, Outcomes of Ahmed glaucoma valve implantation in children with primary congenital glaucoma, Arch Ophthalmol, 2009;127:1436–41.
  15. Freeman PD, Kahook MY, Curtis TH, Glaucoma drainage device implantation in children using fibrin glue, J AAPOS, 2010;14:169–71.
  16. Morad Y, Donaldson CE, Kim YM, et al., The Ahmed drainage implant in the treatment of pediatric glaucoma, Am J Ophthalmol, 2003;135:821–9.
  17. Yang HK, Park KH, Clinical outcomes after Ahmed valve implantation in refractory paediatric glaucoma, Eye (Lond), 2009;23:1427–35.
  18. Englert JA, Freedman SF, Cox TA, The Ahmed valve in refractory pediatric glaucoma, Am J Ophthalmol, 1999;127:34–42.
  19. Kirwan C, O'Keefe M, Lanigan B, Mahmood U, Ahmed valve drainage implant surgery in the management of paediatric aphakic glaucoma, Br J Ophthalmol, 2005;89:855–8.
  20. Al-Mobarak F, Khan AO, Two-year survival of Ahmed valve implantation in the first 2 years of life with and without intraoperative mitomycin-C, Ophthalmology, 2009;116:1862–5.
  21. van Overdam KA, de Faber JT, Lemij HG, de Waard PW, Baerveldt glaucoma implant in paediatric patients, Br J Ophthalmol, 2006;90:328–32.
  22. Tanimoto SA, Brandt JD, Options in pediatric glaucoma after angle surgery has failed, Curr Opin Ophthalmol, 2006;17:132–7.
  23. Djodeyre MR, Peralta Calvo J, Abelairas Gomez J, Clinical evaluation and risk factors of time to failure of Ahmed Glaucoma Valve implant in pediatric patients, Ophthalmology, 2001;108:614 –20.
  24. Banitt MR, Sidoti PA, Gentile RC, et al., Pars plana Baerveldt implantation for refractory childhood glaucomas, J Glaucoma, 2009;18:412–7.
  25. Coleman AL, Smyth RJ, Wilson MR, Tam M, Initial clinical experience with the Ahmed Glaucoma Valve implant in pediatric patients, Arch Ophthalmol, 1997;115:186–91.
  26. Pakravan M, Homayoon N, Shahin Y, Ali Reza BR, Trabeculectomy with mitomycin C versus Ahmed glaucoma implant with mitomycin C for treatment of pediatric aphakic glaucoma, J Glaucoma, 2007;16:631–6.
  27. Colás-Tomás T, Gutiérrez-Díaz E, Tejada-Palacios P, et al., Intermediate results on the use of drainage devices for paediatric glaucoma, Arch Soc Esp Oftalmol, 2012;87:38–43.
  28. al-Hazmi A, Zwaan J, Awad A, et al., Effectiveness and complications of mitomycin C use during pediatric glaucoma surgery, Ophthalmology, 1998;105:1915–20.
  29. Moss EB, Trope GE, Assessment of closing pressure in silicone Ahmed FP7 glaucoma valves, J Glaucoma, 2008;17:489–93.
  30. Christakis PG, Tsai JC, Zurakowski D, et al., Ahmed II, The Ahmed Versus Baerveldt study: design, baseline patient characteristics, and intraoperative complications, Ophthalmology, 2011;118:2172–9.
  31. Nassiri N, Kamali G, Rahnavardi M, et al., Ahmed glaucoma valve and single-plate Molteno implants in treatment of refractory glaucoma: a comparative study, Am J Ophthalmol, 2010;149:893–902.
  32. Tello C, Espana EM, Mora R, et al., Baerveldt glaucoma implant insertion in the posterior chamber sulcus, Br J Ophthalmol, 2007;91:739–42.
  33. Kim DK, Aslanides IM, Schmidt CM Jr, et al., Long-term outcome of aqueous shunt surgery in ten patients with iridocorneal endothelial syndrome, Ophthalmology, 1999;106:1030–4.
  34. Costa VP, Azuara-Blanco A, Netland PA, et al., Efficacy and safety of adjunctive mitomycin C during Ahmed glaucoma Valve implantation: a prospective randomized clinical trial, Ophthalmology, 2004;111:1071–6.
  35. Cantor L, Burgoyne J, Sanders S, et al., The effect of mitomycin C on Molteno implant surgery: a 1-year randomized, masked, prospective study, J Glaucoma, 1998;7:240–6.
  36. Al-Torbak AA, Al-Shahwan S, Al-Jadaan I, Al-Hommadi A, Edward DP, Endophthalmitis associated with the Ahmed glaucoma valve implant, Br J Ophthalmol, 2005;89:454–8.
  37. Gutiérrez-Díaz E, Montero-Rodríguez M, Mencía-Gutiérrez E, et al., Propionibacterium acnes endophthalmitis in Ahmed glaucoma valve, Eur J Ophthalmol, 2001;11:383–5.

Further Resources

Share this Article
Related Content In Paediatric Ophthalmology
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-whiteticktimetranscriptup-arrowwebinar Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72