Evaluation of 350 mm2 End Plate Nonvalved Glaucoma Implant in the Youngest Pediatric Patients
Purpose
To report our experience on the efficacy and complication rate of the 350mm2 End Plate Non-valved Glaucoma Implant Device (GID) in pediatric patients stratified by age, including in the youngest patients.
Methods
Rapid growth of ocular size occurs during the first two years of life and peaks during early adulthood. 44 eyes of 35 patients aged 5 months to 18 years who underwent surgical GID implantation were included and analyzed in one of four age groups: 0-1 year, 1-2 years, 2-10 years, or 10-18 years. Patients were evaluated at 3-9 months, 12-18 months, and 24-30 months after surgery. We defined failure as: postoperative intraocular pressure (IOP) < 6mmHg or > 21mmHg, loss of light perception, removal of the GID, chronic hypotony, retinal detachment, malignant glaucoma, endophthalmitis, phthisis bulbi, or additional glaucoma surgery.
Results
Cumulative probability of success for patients less than one year old (n=7) was 100% at 3-9, 12-18, and 24-30 months. Cumulative probability of success in 1-2 year olds (n=13) was 92.3% at 3-9, 12-18, and 24-30 months. Cumulative probability of success in 2-10 year olds (n=18) was 88.9% at 3-9 months, and 75.2% at 12-18 and 24-30 months. Cumulative probability of success in 10-18 year olds (n=6) was 100% at 3-9 months, and 83.3% at 12-18 and 24-30 months. Comparison of Kaplan-Meier survival curves for each age group by the log-rank test found no significant difference in success rates (p=0.49).
Conclusion
The 350mm2 End Plate Non-valved Glaucoma Implant appeared to be effective even in the youngest pediatric patients, with low rates of complication. The primary complications observed in this study were uncontrolled IOP, replacement of the glaucoma drainage device, and in one case, loss of light perception.