Abstract

P 012

Comparison of glaucoma drainage devices and trabeculectomy with mitomycin C in the treatment of pediatric patients with refractory glaucoma

Helmanová I., Autrata R., Pyrochtová S., Řehůřek J.
Department of Pediatric Ophthalmology, Faculty of Medicine, Masaryk University Hospital, Brno, Czech Republic

Objective: To evaluate and compare the outcomes - effectiveness and safety of glaucoma drainage device (GDD versus trabeculectomy with intraoperative mitomycin C (MMC) use in pediatric glaucomas refractory to conventional surgery and ocular hypotensives therapy.
Methods: Retrospective comparative case series included 51 eyes of 45 children with mean age of 6.3 years (1.3 to 15 years), which received glaucoma drainage devices(Molteno or Baerveldt implant), compared with 46 eyes of 39 patients with mean age 5.7 years (1 to 15 years) which received an MMC trabeculectomy between 1993 and 2005. Clinical outcome assesment IOP control, visual acuity, complications. Surgical outcome was evaluated using Kaplan-Meier life-table analysis. Criteria for success were defined as IOP between 7 and 22 mmHg, no further glaucoma surgery, the absence of visually threatening complications, no loss of light perception. Groups were compared by t-testing, Fischer exact test or Wilcoxan rank-sum test.
Results: The mean preoperative IOP was 34.1 mmHg in the GDD group and 32.7 mmHg for MMC trabeculectomy group, the mean postoperative IOP was 19.1and 25.8 mmHg, respectively (P<0.05). Cumulative probability of success were 89% for the GDD group compared with 63% success in the trabeculectomy group at 1 year and 52% in the GDD group compared with 28% succes in the trabeculectomy group at 5 years (P<0.05). Drainage shunt implantation was associated with more postoperative complications requiring one or more surgical procedures than was MMC trabeculectomy: 23 of 51 eyes (45%) compared to 9 of 46 eyes (19.5%), respectively (P<0.05)
Conclusions: GDD implantation was safe and effective treatment and has a higher success rate of IOP control compared with MMC-trabeculectomy in pediatric glaucoma cases refractive to the initial surgical procedure and medicall therapy. The enhanced success in IOP control with GDD is associated with a higher rate of tube related complications.

Copyright: Porstmann Kongresse GmbH. All rights reserved. Impressum, Disclaimer.