Long-term outlook for paediatric GDI looks good

Paediatric patients do well with glaucoma drainage implants (GDI) in the long-term, but have higher rates of complications than adults - specifically hypotony and endophthalmitis.

"Close monitoring and active management of these complications are of paramount importance to ensure successful paediatric GDI surgery," according to Dr. Achilleas Mandalos from Birmingham and Midland Eye Centre in Birmingham, UK.

A retrospective study of all paediatric patients who underwent GDI by the same surgeon between 2004 to 2011 was performed. Successful outcome was defined as IOP between 6 and 22 mgHg (with or without medication), at least 20 per cent reduction in IOP from the surgery, no devastating vision loss, and no need for further glaucoma surgery. Findings were presented in poster 371 at the 5th World Glaucoma Congress.

Data was based on 52 patients who underwent 69 GDI procedures. Mean follow-up was 45.7 months ranging from 3 to 101 months. Close to 32 per cent had aphakic glaucoma, about 22 per cent had congenital glaucoma and 20 per cent had uveitic glaucoma. A total of 55 per cent had the Baerveldt-250 implant, while the remainder had either the Molteno or Baerveldt-350 implants.

Researchers found that at the last clinic visit, overall success was attained in 66.6 per cent of cases, with 49.3 per cent being defined as a complete success.

Less than 6 months after surgery, 39.1 per cent had hypotony, 21.7 per cent had choroidal effusion, 20.5 per cent of phakic patients had cataracts, and 2.9 per cent developed endophthalmitis. Six months or more after surgery, 13.4 per cent had hypotony, 5.9 per cent had choroidal effusion, 22.9 per cent of phakic patients had cataracts and another and 2.9 per cent developed endophthalmitis.

The outcomes in this group are similar to those in other studies, researchers said.