4
Pediatric glaucoma is a potentially blinding disease, which is often refractive to
medical treatment. Although goniotomy or trabeculotomy have a 50-77% success rate in the
treatment of primary congenital/infantile glaucoma,
1,2
many of the children with pediatric
glaucoma will require other forms of surgical therapy to achieve adequate control of
intraocular pressure. Trabeculectomy with mitomycin C has short-term success rates of 67%
to 100%.
3,4
However, long-term bleb failure, bleb leak and infection are well recognized
complications.
2,5
Cycloablative therapy has a limited success rate and a higher rate of
phthisis.
6,7
Many authors have preferred to reserve cycloablative modalities for eyes that have
failed all other interventions.
First described in pediatric glaucoma patients by Molteno in 1973,
8
the use of
drainage implants has been reported by several authors.
9-21
Success ranges from 44% to 95%
in achieving intraocular pressure (IOP) below 21mmHg. The Ahmed Glaucoma Valve
Implant (New World Medical Inc., Rancho Cucamonga, California) has a unidirectional flow
restriction system that was designed to prevent postoperative hypotony while maintaining
IOP > 8mm Hg.
22
Initial reports in refractory pediatric glaucoma have shown encouraging
results.
10-12
The aim of our study was to evaluate the surgical outcome of this procedure at The
Hospital for Sick Children in a large series of children with glaucoma with a follow up period
of up to 5 years.
