Faculty Bibliography

We present an illustrative case using a modification of the Gaines procedure for the surgical management of patients with spondyloptosis. It involves excision of the inferior half of the body of L5 anteriorly combined with posterior reduction and fusion.

PURPOSE: To evaluate the effectiveness and associated complications of Baerveldt glaucoma implant (BGI) surgery with pars plana tube insertion in aphakic and pseudophakic children. PATIENTS AND METHODS: The medical records of 30 patients (30 eyes) younger than 18 years old with uncontrolled glaucoma associated with aphakia or pseudophakia who underwent pars plana BGI surgery were retrospectively reviewed. Clinical outcome assessment included the measurement of intraocular pressure (IOP) and visual acuity and the identification of complications. Success was defined as 5 mm Hg<final postoperative IOP < or =21 mm Hg with or without glaucoma medications and without visually devastating complications or further glaucoma surgery. Outcomes were evaluated using Kaplan-Meier life-table analysis. RESULTS: Mean follow-up after BGI surgery was 29.8+/-26.4 months. Twelve, 24, and 36-month life-table rates for successful IOP control were 85%, 81%, and 72%, respectively. Six of 30 patients were considered failures. Complications included hypotony (5 patients, with 1 developing hemorrhagic choroidals which required surgical intervention and a second progressing to phthisis), retinal detachment (4 patients), tube obstruction (2 patients), pupillary membrane (1 patient), worsening esotropia (1 patient), focal scleral ectasia (1 patient), and loss of light perception (1 patient). Visually devastating complications were observed in 3 patients (hemorrhagic choroidals 1 patient, phthisis 1 patient, loss of light perception 1 patient). CONCLUSIONS: BGI surgery with pars plana tube insertion is a reasonable option for managing aphakic and pseudophakic children with uncontrolled glaucoma. Complications of BGI surgery related to anterior chamber tube placement, such as tube-cornea touch, are minimized with this approach. The incidence of posterior segment complications, although possibly higher compared with limbal tube insertion, was not excessive