Aqueous shunt devices compared with trabeculectomy with mitomycin-C for children in the first two years of life

PURPOSE: To compare the outcomes of children 24 months of age or younger treated with aqueous shunt devices or with mitomycin-C (MMC) trabeculectomy. DESIGN: Retrospective, age-matched, comparative case series. METHODS: Forty-six eyes of 32 patients with mean age of 7.0 ± 5.1 month (range, 1 to 22 months) and uncontrolled glaucoma, which received an aqueous shunt device (Ahmed glaucoma valve or Baerveldt implant), compared with 24 eyes of 19 patients with mean age of 5.3 ± 4.8 months (range, 0.5 to 24 months), which received an MMC trabeculectomy. Surgical success was defined as intraocular pressure < 23 mm Hg on maximal glaucoma medication, no further glaucoma surgery performed or recommended, no devastating complication, and stable ocular dimensions (axial length and corneal diameter). RESULTS: Cumulative probabilities of success were 87% ± 5.0% for the aqueous shunt group compared with 36% ± 8.0% success in the trabeculectomy group at 12 months and 53% ± 12% in the aqueous shunt group compared with 19% ± 7% in the trabeculectomy group at 72 months (χ² of 23.5, P < .0001). Aqueous shunt implantation was associated with significantly more postoperative complications requiring a return to the operating room (21 of 46 eyes, 45.7%) compared with trabeculectomy with MMC (3 of 24 eyes, 12.5%, P = .0074). The most common postoperative procedure in the aqueous shunt group was tube repositioning, performed in 16 of 46 eyes (34.8%). CONCLUSIONS: Aqueous shunt implantation offers a significantly greater chance of successful glaucoma control in the first 2 years of life, compared with trabeculectomy with MMC. However, the enhanced success with aqueous shunt devices is associated with a higher likelihood of postoperative complications requiring surgical revision, most commonly tube repositioning.