Long-term outcomes of Ahmed glaucoma drainage device capsulectomies in pediatric glaucoma patients.

Abstract

Purpose: To investigate the long-term outcomes associated with Ahmed glaucoma device capsulectomy in pediatric patients at a single institution over a period of nearly 10 years, from 2011 to 2021.

Methods: We retrospectively reviewed the medical records of pediatric glaucoma patients with FP-7 Ahmed glaucoma device capsulectomies performed by three surgeons. Surgical success was defined as post-capsulectomy IOP of <21 mm Hg at most recent follow-up without need for additional procedures, regardless of topical medications.

Results: A total of 22 capsulectomies of 22 eyes of 18 patients aged 1-17 years were reviewed. Median post-capsulectomy follow-up was 5.8 years. Etiologies of glaucoma were primary congenital glaucoma (50%), anterior segment dysgenesis (32%), Sturge-Weber syndrome (14%), and angle recession (5%). Pre-capsulectomy IOP was 30 ± 6.2 mm Hg, with first postoperative IOP of 15 ± 8.0 mm Hg. Surgical success was achieved with 5 capsulectomies (23%), with follow-up of 1.5-5.9 years. Post-capsulectomy complications included short-term hypotony in 1 eye (5%) and macular edema in 1 eye (5%). Eleven of 22 eyes (50%) had at least one repeat placement of Ahmed glaucoma device, with median time to repeat surgery of 80 months.

Conclusions: In pediatric glaucoma patients with glaucoma drainage device encapsulation, capsulectomy likely does not prevent additional surgery in most children over the long term, but may serve as a temporizing measure before other interventions.