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American Journal of Ophthalmology - AJO 2875 (Page 12)

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American Journal of Ophthalmology - AJO 2875
12
Discussion
Management of pediatric glaucoma that does not respond satisfactorily to medical
treatment or is not considered suitable for angle or filtering surgery is difficult. The higher
failure rate of trabeculectomy in children and long-term complications of intraoperative
antimetabolites warrant consideration of alternative interventions.
23-24
Because of associated
complications including chronic hypotony, phthisis and cataract, cyclodestruction is often
reserved for eyes that have poor visual acuity or have failed all other options.
25
We have
therefore explored the role of Ahmed implant insertion in our pediatric patients. To the best
of our knowledge and as evident from a Medline literature search, this is the largest series
reported with the longest follow up period.
The reported success rate of drainage implants in children varies from 44 to 95%.
9-20
Coleman and co-authors reported an overall success rate of 78% and 61% using the Ahmed
drainage implant,
10
and Englert and coworkers reported an overall success rate of 91% and
58% during the same follow up period.
11
It should be noted that 37% of the eyes in the latter
group had at least one cycloablation procedure prior to Ahmed implantation. Recently,
Djodeyre and colleges reported their experience in implanting 35 Ahmed tubes in the eyes of
29 pediatric glaucoma patients. They reported an over whole success rate of 70% and 63% at
12 and 24 months respectively.
21
In the sub-population of Sturge Weber glaucoma patients,
Hamush et al reported a 79% and 30% success rate in controlling IOP at 12 and 60 months
respectively.
12
Our results with the 12 Sturge Weber patient's eyes in this series were more
favorable with 100% success at one year and 85% success at 5 years. It may be that our more
favorable result stems from the fact that we did not use the Ahmed implant as a "last resort"
but rather as a first line of surgical treatment in some patients. Only 1 of 14 such patients
failed and this failure was due to self-inflicted trauma. Our findings support the observation

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