Aqueous drainage device surgery in refractory pediatric glaucoma: II. Ocular motility consequences

PURPOSE To determine the prevalence of complications relating to ocular motility and alignment in children with refractory congenital and aphakic glaucoma treated with aqueous drainage device surgery. METHODS Chart review of consecutive children treated with aqueous drainage devices at Duke University Eye Center from 1995 to 2006 for ocular motility abnormalities and strabismus as well as sensorimotor testing results before and after aqueous drainage device placement. RESULTS Thirty-eight eyes of 30 children with congenital glaucoma and 41 eyes of 32 children with aphakic glaucoma were included. Optotype visual acuity testing could be performed in a minority of children preoperatively. After aqueous drainage device surgery, 14 and 20 eyes, respectively, were >20/100 in the congenital glaucoma and aphakic glaucoma groups. Only a few children had stereopsis or demonstrated binocular function on Worth 4-Dot testing in both groups before and after aqueous drainage device surgery. Horizontal and vertical strabismus was common, especially after aqueous drainage device surgery and occurred in 57% of congenital glaucoma patients and 47% of aphakic glaucoma patients. Motility limitation (both vertical and horizontal) was also common and occurred in 37% overall. DISCUSSION Ocular motility abnormalities and strabismus were common in children after aqueous drainage device surgery. These potential problems should be considered when aqueous drainage device surgery is planned, especially in children with binocularity.