Scleral-Tunneled, Graft-Free Glaucoma Drainage Device Implantation in Children: Outcomes from a US Tertiary Center.
TL;DR
ST-GDD resulted in sustained IOP reduction, decreased medication burden, and zero tube exposures, the first US report of ST-GDD outcomes in children, and long-term prospective comparisons with conventional patch-graft techniques are needed.
Abstract
Objective
To report IOP outcomes, medication use, tube exposure rates, and surgical durability following ST-GDD in children.
Design
Retrospective cohort study SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: 40 eyes (32 patients) under age 18 undergoing ST-GDD at the University of Minnesota (2018-2025) with at least 6 months of follow-up. METHODS, INTERVENTION, OR TESTING Fourteen eyes received an Ahmed FP-7 valve (New World Medical) and 26 a Baerveldt 350 implant (Alcon). MAIN OUTCOMES AND MEASURES Primary outcome was IOP control at 6 months and final follow-up. Four groups were analyzed: 1) complete success (IOP 6-21 mm Hg off medications), 2) qualified success (6-21 mm Hg on medications), 3) tolerable success (22-25 mm Hg without progression), or 4) failure (IOP above target, systemic acetazolamide, loss of light perception, or major reoperation). Kaplan-Meier analyses were performed using both a traditional clinical definition (failure = group 4) and a more stringent ("austere") definition (failure = groups 3 and 4). Tube exposure was the primary safety endpoint.
Results
Mean age was 90.81 months; 71.9% were male. Preoperative mean IOP was 34.5 mm Hg (SD, 6.2) on 3.8 medications (SD, 0.9). At 6 months, IOP fell to 15.75 mm Hg (mean difference, -18.75; 95% CI, -20.8 to -16.7; P < .001) and medications to 0.42 (mean difference, -3.38; 95% CI, -3.73 to -3.02; P < .001). At final follow-up (mean, 36.7 months; range, 6-90 months), mean IOP was 17.78 mm Hg on 0.98 medications (both P < .001 vs baseline). At 6 months, 77.5% achieved complete and 17.5% qualified success with no failures; at final follow-up, 50% complete, 30% qualified, 15% tolerable, and 5% failure. Kaplan-Meier estimated clinical success was 93% and austere success 71.1%; most failures occurred within 32 months. No tube exposures or erosions were observed.
Conclusions
This is the first US report of ST-GDD outcomes in children. During a mean follow-up of 36.7 months (range, 6-90 months), ST-GDD resulted in sustained IOP reduction, decreased medication burden, and zero tube exposures. Longer-term prospective comparisons with conventional patch-graft techniques are needed.