TOPLINE

In children with difficult-to-treat glaucoma, the nonvalved Paul Glaucoma Implant yielded sustained reductions in intraocular pressure (IOP) and medication use for up to 5 years.

METHODOLOGY

• Researchers conducted a retrospective cohort study to evaluate the efficacy of a glaucoma drainage device with a flexible and biocompatible silicone plate in a pediatric glaucoma cohort.
• They analyzed 113 eyes from 83 pediatric patients (mean age, 9 years; 49.6% girls) who underwent implantation of the device at a UK eye hospital, with follow-up of up to 5 years.
• Patients had refractory glaucoma diagnoses: primary congenital glaucoma (22.1%), aphakic glaucoma (26.5%), uveitic glaucoma (30.1%), juvenile open-angle glaucoma (7.1%), and other types (15.0%).
• All surgeries were performed under general anesthesia by a single surgeon.
• The study measured changes in IOP, medication use, complications, and surgical success over time; complete success was defined as achieving an IOP of 6-21 mm Hg without medications and qualified success as an IOP of 6-21 mm Hg with or without medications.

TAKEAWAY

• The mean IOP decreased from 27.2 mm Hg preoperatively to 14 mm Hg at 12 months and 13.7 mm Hg at 24 and 60 months (P < .001 for all).
• The mean number of antiglaucoma medications decreased from 3.8 preoperatively to 0.9 at 12 and 24 months and 0.7 at 60 months (P < .001 for all), with 59% of eyes achieving medication-free status at final follow-up.
• Qualified success was achieved by 91.2% of eyes at 1 year, 88.5% at 2 years, 85.8% at 3 years, and 81.4% at 5 years.
• A Prolene stent, placed initially to reduce the risk for dangerously low IOP after surgery, was later removed in about 37% of eyes to improve drainage, leading to further drops in IOP and medication use. Major adverse events included device exposure (2.7%) and very low IOP (2.7%).

IN PRACTICE

“We observed sustained reductions in IOP and medication burden, with an acceptable safety profile across a heterogeneous cohort of childhood glaucoma cases,” the researchers of the study reported.

SOURCE

The study was led by Clarissa Ern Hui Fang, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, England. It was published online on July 14 in Eye.

LIMITATIONS

The retrospective design and progressive loss to follow-up constrained the analysis, with only 16 eyes evaluable at 60 months. Loss to follow-up may have introduced bias because patients with poorer outcomes are usually more likely to discontinue follow-up.

DISCLOSURES

The authors declared no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.