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Experience with Paul glaucoma implant in childhood glaucoma
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Introdução: O glaucoma pediátrico é uma neuropatia ótica progressiva sendo responsável por cerca de 10% da cegueira em crianças. O principal fator de risco é o aumento da pressão intraocular (PIO) sendo uma patologia maioritariamente de tratamento cirúrgico.
A cirurgia de dispositivos de drenagem do glaucoma (DDG) é uma das opções disponíveis quando a cirurgia do ângulo falha, é impossível de realizar ou tem baixa probabilidade de ser bem-sucedida. Os DDG podem ser considerados terapêutica de primeira linha em doentes com cicatrização prévia da conjuntiva, doentes muito novos ou afáquicos, com necessidade de uso de lentes de contacto ou intervenções cirúrgicas subsequentes. Em comparação com a trabeculectomia com mitomicina C (MMC), os DDG estão associados a menos complicações e a uma menor necessidade de procedimentos subsequentes e examinações sob anestesia, pelo que são vantajosos na idade pediátrica, em que a anestesia geral está associada a efeitos adversos a nível do neurodesenvolvimento. Existem vários tipos de DDG, que partilham uma estrutura básica comum, ainda que tenham algumas diferenças em termos de forma, tamanho e material – influenciando a resposta cicatricial e as características da cápsula fibrosa responsável pelo reservatório de humor aquoso que se forma sob o dispositivo. Os DDG mais estudados no contexto do glaucoma pediátrico são os dispositivos não valvulados como o Molteno e a Baerveldt (BGI) e os dispositivos valvulados como a válvula de Ahmed (AGV). Não existe uma clara superioridade em relação a um dispositivo específico, ainda que possa ser sugerida uma superioridade da BGI em termos de redução da PIO e uma superioridade da AGV no que diz respeito a perfil de segurança (nomeadamente em olhos com maior risco de hipotonia ou com necessidade de redução rápida da PIO).
Introduction: Glaucoma drainage device (GDD) surgery is a successful intervention in pediatric glaucoma, to be considered when angle surgery fails, it’s impossible to perform or deemed unlikely to succeed. A literature review regarding GDD in children was performed. Purpose: To report the success rate associated with the Paul glaucoma implant (PGI), a new non-valved GDD with a tube internal diameter of 127μm (the smallest in the market). Secondary outcomes were variation in the number of glaucoma medications, intraocular pressure (IOP) and best corrected visual acuity (BCVA) as well as analysis of complications. Methods: A retrospective chart review was conducted based on clinical registries of all children that underwent PGI implantation for pediatric glaucoma between January 2019 and May 2020. Success was defined as a postoperative IOP between 6-20 mmHg as well as a 20% reduction from baseline values with (qualified success) or without (complete success) additional glaucoma medications, no loss of light perception, need for further glaucoma surgical intervention or need for removal of the GDD. Results: 7 eyes of 6 children underwent PGI implantation, with a mean follow up of 12.1 ± 4.6 months. The complete success rate was 42.9% (n = 3) and the qualified success was 100% (n=7). Complications occurred in 85.7% (n = 6) of the eyes, but none of them were sight-threatening and most resolved with medical therapy. There was a statistically significant reduction in IOP and number of glaucoma medications. Changes in BCVA were not statistically significant. Conclusions: Paul glaucoma implant is a successful and relatively safe alternative to other commonly used glaucoma implants in children with pediatric glaucoma.
Introduction: Glaucoma drainage device (GDD) surgery is a successful intervention in pediatric glaucoma, to be considered when angle surgery fails, it’s impossible to perform or deemed unlikely to succeed. A literature review regarding GDD in children was performed. Purpose: To report the success rate associated with the Paul glaucoma implant (PGI), a new non-valved GDD with a tube internal diameter of 127μm (the smallest in the market). Secondary outcomes were variation in the number of glaucoma medications, intraocular pressure (IOP) and best corrected visual acuity (BCVA) as well as analysis of complications. Methods: A retrospective chart review was conducted based on clinical registries of all children that underwent PGI implantation for pediatric glaucoma between January 2019 and May 2020. Success was defined as a postoperative IOP between 6-20 mmHg as well as a 20% reduction from baseline values with (qualified success) or without (complete success) additional glaucoma medications, no loss of light perception, need for further glaucoma surgical intervention or need for removal of the GDD. Results: 7 eyes of 6 children underwent PGI implantation, with a mean follow up of 12.1 ± 4.6 months. The complete success rate was 42.9% (n = 3) and the qualified success was 100% (n=7). Complications occurred in 85.7% (n = 6) of the eyes, but none of them were sight-threatening and most resolved with medical therapy. There was a statistically significant reduction in IOP and number of glaucoma medications. Changes in BCVA were not statistically significant. Conclusions: Paul glaucoma implant is a successful and relatively safe alternative to other commonly used glaucoma implants in children with pediatric glaucoma.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Glaucoma pediátrico Dispositivos de drenagem de glaucoma Implante de glaucoma Paul Oftalmologia