Fibrotic response after Baerveldt glaucoma drainage device surgery: an initial sight-threatening sign in eyes with refractory childhood glaucoma

PURPOSE: We report the pathological analysis of a postoperative fibrotic reaction as an initial sign of a sight-threatening complication observed during the 2-year outcomes follow up of Baerveldt glaucoma implant (BGI) surgery in eyes with refractory childhood glaucoma. STUDY DESIGN: Retrospective case series. METHODS: Fifteen eyes of 10 patients with refractory childhood glaucoma underwent BGI surgery between 2013 and 2020 at the University of Osaka Hospital. Patients were followed for a minimum of 2 years postoperatively. We investigated the postoperative complications, and histopathologically analyzed the specimens obtained from three eyes with postoperative fibrous membranes on the irises. RESULTS: Nine eyes (60%) had a postoperative fibrous membrane around the tube or on the iris close to the tube, whereas two eyes developed a tractional retinal detachment. The pathological results indicated the tissues were eosinophilic fibrous scar tissues that did not have inflammatory or neoplastic lesions. CONCLUSION: BGI surgery was effective in patients with refractory childhood glaucoma. However, clinicians should be alert to the potential for development of fibrotic ocular inflammation in refractory childhood glaucoma eyes.