Přínos drenážních implantátů v léčbě dětského glaukomu

MUDr. Inka Krejčířová, Ph.D.

Disertační práce

Contribution of glaukoma drainage implants in the treatment of pediatric glaucoma

Anotace:

The aim of presented study is to evaluate the effectiveness and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy. The study included 84 children (84 eyes) younger than 18 years who underwent glaucoma drainage device implantation in our clinic between 1990 and 2008. The mean age at time of surgery was 6.2 ± 5.3 years (range: 3months to 17.5 years). Intraocular pressure (IOP), visual acuity, intraoperative and postoperative complications and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, and the absence of visually threatening complications, no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1 ± 5,9 years (range: 0.9 to 16.2 years). Mean preoperative and postoperative IOP was 34.2 ± 8.1 mmHg and 17.8 ± 6.6 mmHg (p<0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 89% at 2 years, 76% at 3 years, 69% at 4 years, 64% at 5 years and 66% at six years. There was no difference between primary (n=35 eyes) and secondary glaucoma (n=49 eyes) patients in terms of cumulative success (p = 0.247), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. At the end of the follow up period 59 from 84 implantations were evaluated as success. Fifteen eyes (29.8%) failed with these causes: 21 (25%) eyes with uncontrolled IOP, two (2,4%) eyes of retinal detachment and 2 (2,4%) eyes with no light perception. Statistical regression model did not show influence of age, gender and previous surgery, type of implant, type of glaucoma, preoperative NOT and number of glaucoma medications. The treatment of refractory glaucoma in children remains to be a difficult task. In the case the initial surgical methods fail or their prognosis is poor and pharmacotherapy is unsuccessful, the Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment choice. Similar success rate has been observed in both primary and secondary glaucoma patients. Patients often require postoperative adjunctive pharmacotherapy for the long-term intraocular pressure control. The success rate lowers with the length of the follow up period. There are many postoperative complications linked to the drainage implants, most of them are reversible and can be solved by surgical revision.

Abstract:

The aim of presented study is to evaluate the effectiveness and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy. The study included 84 children (84 eyes) younger than 18 years who underwent glaucoma drainage device implantation in our clinic between 1990 and 2008. The mean age at time of surgery was 6.2 ± 5.3 years (range: 3months to 17.5 years). Intraocular pressure (IOP), visual acuity, intraoperative and postoperative complications and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, and the absence of visually threatening complications, no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1 ± 5,9 years (range: 0.9 to 16.2 years). Mean preoperative and postoperative IOP was 34.2 ± 8.1 mmHg and 17.8 ± 6.6 mmHg (p<0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 89% at 2 years, 76% at 3 years, 69% at 4 years, 64% at 5 years and 66% at six years. There was no difference between primary (n=35 eyes) and secondary glaucoma (n=49 eyes) patients in terms of cumulative success (p = 0.247), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. At the end of the follow up period 59 from 84 implantations were evaluated as success. Fifteen eyes (29.8%) failed with these causes: 21 (25%) eyes with uncontrolled IOP, two (2,4%) eyes of retinal detachment and 2 (2,4%) eyes with no light perception. Statistical regression model did not show influence of age, gender and previous surgery, type of implant, type of glaucoma, preoperative NOT and number of glaucoma medications. The treatment of refractory glaucoma in children remains to be a difficult task. In the case the initial surgical methods fail or their prognosis is poor and pharmacotherapy is unsuccessful, the Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment choice. Similar success rate has been observed in both primary and secondary glaucoma patients. Patients often require postoperative adjunctive pharmacotherapy for the long-term intraocular pressure control. The success rate lowers with the length of the follow up period. There are many postoperative complications linked to the drainage implants, most of them are reversible and can be solved by surgical revision.

Klíčová slova

Glaukomový drenážní implantát, Dětský glaukom, Nitrooční tlak, Molteno implantát, Baerveldt implantát Key words, Glaucoma drainage implant, Pediatric glaucoma, Intraocular pressure, Molteno implant, Baerveldt implant

Jazyk práce: čeština

Datum vytvoření / odevzdání či podání práce: 6. 4. 2010

Obhajoba závěrečné práce

• Obhajoba proběhla 6. 10. 2010
• Vedoucí: prof. MUDr. Rudolf Autrata, CSc.

Masarykova univerzita

Lékařská fakulta

Doktorský studijní program / obor:
Oftalmologie (čtyřleté) / Oftalmologie