Concurrent adjacent strabismus surgery with glaucoma drainage device placement in childhood glaucomas

Background Determine outcomes of concurrent strabismus surgery with placement of a glaucoma drainage device (GDD) in children.Methods Retrospective review of pediatric patients who underwent simultaneous lateral rectus (LR) muscle surgery with superotemporal GDD placement. Strabismus and GDD success were defined as residual horizontal misalignment < 10 prism diopter (PD) and intraocular pressure (IOP) < 21 mmHg, no visually devastating complications, and no additional IOP-lowering surgeries.Results Fifteen eyes of 13 patients (69% male) underwent LR surgery (14 recessions, 1 resection) for exotropia or esotropia simultaneous with GDD placement (13 Baerveldt, 2 Ahmed) at 8.34 +/- 5.26 years. Preoperative visual acuity (VA) in operative eye (0.89 +/- 0.54) was worse than non-operative eye (0.23 +/- 0.44, p = 0.0032). Preoperative horizontal deviation was 38.3 +/- 9.4 PD and LR recession was 7.4 +/- 1.1 mm. At final follow-up, VA in operative eye (0.87 +/- 0.52) was unchanged from preoperative (p = 0.4062). Final IOP was significantly decreased (12.4 +/- 4.7 mmHg vs. 31.1 +/- 11.4 mmHg, p = 0.0001) as was number of glaucoma medications (2.7 +/- 1.7 vs. 1.1 +/- 1.3, p = 0.0037). Five (38%) and 9 patients (69%) met criteria for strabismus and GDD success, respectively. Two eyes required tube revision and endoscopic cyclophotocoagulation and 2 eyes had additional strabismus surgery.Conclusions Concurrent strabismus and GDD surgery decreased horizontal deviation and obtained IOP control. It is important to consider correction of strabismus at time of GDD placement to maximize visual development and improve cosmesis in children with glaucoma.