Long-term Effects of Tube-shunt Procedures on Management of Refractory Childhood Glaucoma

Purpose: The authors evaluated the long-term results of tube-shunt surgery in management of childhood glaucoma. Methods: The results of tube-shunt surgery in children who had glaucoma refractory to medical or alternative surgical treatment in the Glaucoma Service of wills Eye Hospital during the period 1986 through 1993 were reviewed. Eighteen eyes of 15 patients were included in the analysis. Follow-up ranged from 14 to 80 months (mean ± standard deviation, 47.3 ± 25.1 months). Results: In the early postoperative course (6 months after surgery), the intraocular pressure (10P) was between 6 and 21 mmHg in 13 eyes (72.2%) with or without glaucoma medication. Two or more years later, IOP was between 6 and 21 mmHg in four eyes without further glaucoma medication (22.2%) and four eyes (22.2%) with the addition of anti hypertensive therapy. Five eyes (27.8%) lost light perception, whereas seven (38.9%) remained within one line of preoperative vision or improved. Twelve eyes underwent 28 additional surgical procedures after the tube-shunt operation, mostly to control IOP or manage tube-related complications. Conclusion: The limited success rate, relatively high complication rate, and need for frequent surgical intervention suggest caution regarding the prognosis of tube-shunt surgery in children with glaucoma.