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

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.