Original article
Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life

https://doi.org/10.1016/S0002-9394(03)00714-1Get rights and content

Abstract

Purpose

To compare the outcomes of children 24 months of age or younger treated with aqueous shunt devices or with mitomycin-C (MMC) trabeculectomy.

Design

Retrospective, age-matched, comparative case series.

Methods

Forty-six eyes of 32 patients with mean age of 7.0 ± 5.1 month (range, 1 to 22 months) and uncontrolled glaucoma, which received an aqueous shunt device (Ahmed glaucoma valve or Baerveldt implant), compared with 24 eyes of 19 patients with mean age of 5.3 ± 4.8 months (range, 0.5 to 24 months), which received an MMC trabeculectomy. Surgical success was defined as intraocular pressure < 23 mm Hg on maximal glaucoma medication, no further glaucoma surgery performed or recommended, no devastating complication, and stable ocular dimensions (axial length and corneal diameter).

Results

Cumulative probabilities of success were 87% ± 5.0% for the aqueous shunt group compared with 36% ± 8.0% success in the trabeculectomy group at 12 months and 53% ± 12% in the aqueous shunt group compared with 19% ± 7% in the trabeculectomy group at 72 months (χ2 of 23.5, P < .0001). Aqueous shunt implantation was associated with significantly more postoperative complications requiring a return to the operating room (21 of 46 eyes, 45.7%) compared with trabeculectomy with MMC (3 of 24 eyes, 12.5%, P = .0074). The most common postoperative procedure in the aqueous shunt group was tube repositioning, performed in 16 of 46 eyes (34.8%).

Conclusions

Aqueous shunt implantation offers a significantly greater chance of successful glaucoma control in the first 2 years of life, compared with trabeculectomy with MMC. However, the enhanced success with aqueous shunt devices is associated with a higher likelihood of postoperative complications requiring surgical revision, most commonly tube repositioning.

Section snippets

Methods

A retrospective review of medical records identified all patients 24 months of age or younger who underwent aqueous shunt implantation by two surgeons (A.D.B. and S.F.F.) at their respective institutions from August 1994 to October 2001. Follow-up for these patients is reported through July 2002. Institutional review board approval was obtained for data review and analysis. The cohort receiving an aqueous shunt device was compared with an age-matched cohort of patients receiving MMC

Results

Forty-six eyes of 32 patients were identified that underwent aqueous shunt implantation before 25 months of age. Twenty-four eyes of 19 patients that underwent mitomycin trabeculectomy in this same age group were used for comparison. Table 1 summarizes the demographics of these two groups. Statistical analyses of the two groups were not significant for age at surgery, prior surgeries, or diagnostic groups. There was a trend for more aphakic eyes in the aqueous shunt group of borderline

Discussion

The efficacy and safety of aqueous shunt devices and trabeculectomy with adjunctive MMC for glaucomas occurring in childhood have been established in previous studies.4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 However, pediatric glaucomas are much less common than adult-onset glaucoma and are representative of a much wider spectrum of pathology. Wide variation in treatment may be recommended by centers experienced in the treatment of pediatric glaucoma. Randomized, prospective

References (43)

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This work was supported, in part, by an unrestricted grant from Research to Prevent Blindness, New York, New York, and by an NEI Departmental Core Grant (P30 EY06360).

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