Risk Factors for Glaucoma Drainage Device Failure and Complication in the Pediatric Population

Purpose: Report factors associated with failure and complication in a cohort of children who have undergone glaucoma drainage device (GDD) implantation. Design: Retrospective case series. Participants: Consecutive pediatric GDD eyes that met criteria between May 1997 and July 2019. Methods: Entries were included for analysis if age <18 years at the time of GDD implantation. Failure was defined as an intraocular pressure (10P) greater than 21 mmHg or IOP reduction <20% or IOP <5 mmHg at 2 consecutive follow-up visits >3 months after implantation, reoperation for glaucoma, or loss of light perception vision. Complications were defined as postoperative events due to the GDD that required additional examination under anesthesia or additional surgery. Main Outcome Measures: Survival analyses of surgical failures and complications. Results: Over a mean follow-up period of 5.4 years, 58 (38%) of 150 first-time GDD implants failed. Glaucoma associated with acquired conditions had decreased risk for failure when compared with glaucoma secondary to nonacquired systemic diseases (hazard ratio [HR], 12; P = 0.0063), nonacquired ocular anomalies (HR, 12; P = 0.0054), and primary congenital glaucoma (HR, 5.4; P = 0.041). There was an increased risk of failure for first-time tubes in younger patients with a 23% reduction of failure with each 3-year increase in age (HR, 0.77; P = 0.034). A total of 38 (25.3%) of the first-time GDD implantations had a complication. Higher preoperative IOP (5 mmHg increase; HR, 1.2; P = 0.038) and younger age (<3 years; HR, 2.1; P = 0.024; < 2 years, HR, 1.9; P = 0.046) increased the risk of complication. There were 22 second-time GDD implants in the study, of which 11 failed (50%), and increased risk for failure was associated with younger age at the time of implantation (<1 year; HR, 27; P = 0.0053) and concurrent glaucoma-related procedures with or without non-glaucoma anterior segment surgery at the time of implantation (HR, 13; P = 0.0085). Conclusions: Although GDD implantation in children is relatively safe and effective, these data should be interpreted in the context of children's relative longevity. These findings offer an outcome metric to which future novel glaucoma procedures in children can be compared. (C) 2020 by the American Academy of Ophthalmology