Two-Staged versus Single-Staged Baerveldt Implantation in Children with Glaucoma

PURPOSE: To compare 2-staged versus single-staged Baerveldt implantation in children with glaucoma. DESIGN: Retrospective observational case series. SUBJECTS: Children (<18 years of age) who underwent Baerveldt glaucoma drainage device (GDD) placement with at least 6 months of postoperative follow-up. METHODS: Review of patients with at least 6 months of follow-up who underwent 2-stage Baerveldt placement (n = 25) between 2010 and 2025 and diagnosis and age-matched controls who had 1-stage Baerveldt placement (n = 40). Demographics, ocular diagnoses and surgeries, and examination findings (best-corrected visual acuity [BCVA], intraocular pressure [IOP], and glaucoma medications) were collected. MAIN OUTCOME MEASURES: Success and survival of Baerveldt GDD (IOP 5-21 mmHg, no additional IOP-lowering surgeries, and no visually devastating complications), BCVA, IOP, and glaucoma medications. RESULTS: Children in the 2-stage Baerveldt and single-stage Baerveldt (control) groups showed no difference in age at surgery, type of glaucoma, prior glaucoma and intraocular surgeries, or length of follow-up. There was also no significant difference in BCVA, IOP, or number of glaucoma medications between the 2 groups before operation or at final follow-up. However, there were fewer patients whose vision worsened between the preoperative and final examinations in the staged group (P = 0.0011). In both groups, final IOP (P < 0.0001) and number of glaucoma medications (P < 0.05) were significantly decreased compared with the preoperative examination. Success at final follow-up was 64% in the 2-stage group and 60% in the controls, and there was no difference in survival curves (P = 0.6629). Greater number of prior glaucoma surgeries was associated with increased risk of failure (odds ratio, 1.7; 95% confidence interval, 1.4-2.2). CONCLUSIONS: Two-staged Baerveldt placement in children obtained IOP control on fewer medications and showed similar success and survival rates to children who underwent single-staged Baerveldt surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.