Comparison of Visual Acuity and Strabismus Pre- and Post-Baerveldt 350 Glaucoma Drainage Device Placement in Refractory Childhood Glaucomas

Objective: Assess visual acuity (VA) and strabismus changes in children after Baerveldt 350 (BV350) device placement. Methods and Analysis: Retrospective cohort study of children (<21 years of age) who had superotemporal BV350 placement (2011–2023) and >6-month follow-up. Ocular diagnoses, surgical details, and preoperative and final follow-up exam findings were collected. In bilateral cases, first eye implanted was included in analysis. Results: Ninety-seven patients underwent BV350 surgery with median age of 6.7 (interquartile (IQR) 3.1, 11.2) years and with a median of 4.2 (IQR 1.8, 6.8) years of follow-up. Most common glaucomas were secondary to non-acquired ocular anomaly (n = 31) or primary congenital glaucoma (n = 21). There was no difference in preoperative and final VA (p = 0.6583). Twenty-seven (28%) and twenty-five (26%) patients were orthophoric preoperatively and at final follow-up, respectively. Orthophoria at final follow-up was associated with preoperative (odds ratio (OR)1.8 [1.2, 2.9]) and final VA (OR1.5 [1.1, 2.3]). At final follow-up, 13 patients (13%) and 19 patients (20%) showed worsened or improved horizontal deviation (>10 prism diopter (PD) change), respectively. No patients reported postoperative diplopia. Only four patients, all with esotropia, underwent subsequent strabismus surgery. Conclusions: Children who underwent BV350 placement did not have significant change in VA, and a high percentage of patients had strabismus prior to (72%) and following (74%) glaucoma surgery. Orthophoria was associated with better VA. The majority of patients did not show worsening of strabismus postoperatively, and none reported diplopia.