Risk factors for receiving both scleral buckle and glaucoma drainage device in children

We conducted a retrospective review of patients (< 18 years) between 2013 and 2021 to determine risk factors of pediatric patients receiving a glaucoma drainage device (GDD) needing a scleral buckle (SB) and vice versa. The first population underwent an SB placement with no prior GDD. The second underwent a GDD implantation with no prior SB. We analyzed 133 eyes in the SB-first group. The common indications were retinal detachment associated with a syndrome/disease (41.2%), blunt trauma (21%), and non-syndromic pathologic myopia (11%). Twelve eyes (9%) required subsequent GDD implantation with a mean time to reoperation of 19.73 months (median 2.3 months). Eyes with trauma had a 5-fold risk (hazard ratio [HR] 4.81, p = 0.0069) of requiring a subsequent GDD. Each additional glaucoma medication before initial SB surgery increased the risk by 1.81 (p = 0.0096). 135 eyes were in the GDD-first group. Four eyes (3%) required a subsequent SB. The mean time to reoperation was 17 months (median 9.2 months). There was a statistically significant association with trauma (HR 12.3, p = 0.0341) only. Pediatric eyes with a history of trauma and/or multiple glaucoma medications before intervention have a high risk of requiring both an SB and GDD.