Aqueous shunt devices compared with trabeculectomy with Mitomycin-C for children in the first two years of life.
OBJECTIVE
To compare the outcomes of children 24 months of age or younger treated with aqueous shunt devices or with mitomycin-C (MMC) trabeculectomy.


METHODS
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 (chi(2) 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.
Beck
Allen D
AD
Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia 30322, USA. abeck@emory.edu
Freedman
Sharon
S
Kammer
Jeffrey
J
Jin
Jing
J
D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D001082:Aqueous Humor / Q000378:metabolism; D003131:Combined Modality Therapy; D005901:Glaucoma / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D016685:Mitomycin / Q000627:therapeutic use*; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin