The aim of presented study is to evaluate the effectiveness and
safety of glaucoma drainage implants (Molteno and Baerveldt
devices) in primary and secondary childhood glaucomas
refractory to conventional surgical treatments and medical
therapy.
	The study included 84 children (84 eyes) younger than
18 years who underwent glaucoma drainage device implantation in
our clinic between 1990 and 2008. The mean age at time of
surgery was 6.2 ± 5.3 years (range: 3months to 17.5 years).
Intraocular pressure (IOP), visual acuity, intraoperative and
postoperative complications and number of glaucoma medications
were evaluated. Criteria for success were defined as IOP
between 7 and 22 mmHg with or without glaucoma medications, no
further glaucoma surgery, and the absence of visually
threatening complications, no loss of light perception. Results
were compared for children with primary and secondary
glaucomas. The mean follow-up was 7.1 ± 5,9 years (range: 0.9
to 16.2 years).
	Mean preoperative and postoperative IOP was 34.2 ± 8.1
mmHg and 17.8 ± 6.6 mmHg (p<0.001), respectively. Kaplan-Meier
survival analysis showed cumulative probability of success: 93%
at 6 months, 91% at 1 year, 89% at 2 years, 76% at 3 years, 69%
at 4 years, 64% at 5 years and 66% at six years.   There was no
difference between primary (n=35 eyes) and secondary glaucoma
(n=49 eyes) patients in terms of cumulative success (p =
0.247), final IOP, number of medications, or length of
follow-up. On average, the GDI surgery was successful for a
mean period of 6.7 years.  At the end of the follow up period
59 from 84 implantations were evaluated as success. Fifteen
eyes (29.8%) failed with these causes: 21 (25%) eyes with
uncontrolled IOP, two (2,4%) eyes of retinal detachment and 2
(2,4%) eyes with no light perception. Statistical regression
model did not show influence of age, gender and previous
surgery, type of implant, type of glaucoma, preoperative NOT
and number of glaucoma medications.
	The treatment of refractory glaucoma in children
remains to be a difficult task. In the case the initial
surgical methods fail or their prognosis is poor and
pharmacotherapy is unsuccessful, the Molteno and Baerveldt
glaucoma drainage implants surgery seems to be safe and
effective treatment choice. Similar success rate has been
observed in both primary and secondary glaucoma patients. 
Patients often require postoperative adjunctive pharmacotherapy
for the long-term intraocular pressure control. The success
rate lowers with the length of the follow up period. There are
many postoperative complications linked to the drainage
implants, most of them are reversible and can be solved by
surgical revision.