Aqueous shunt may be effective as first-line treatment for uveitic glaucoma

Acta Ophthalmol. 2010;88(1):33-36.

An aqueous shunt used as a primary treatment reduced IOP in eyes with uveitic glaucoma, according to a study.

"The treatment of uveitic glaucoma is very challenging because of many different mechanisms that elevate the intraocular pressure," the study authors said. "The primary treatment is always medical, although the use of drugs such as prostaglandin agonists and pilocarpine is limited because they may aggravate the inflammatory reaction in the eye. Therefore, surgical treatment is often needed."

The retrospective study included 30 patients with a mean age of 37.9 years who underwent unilateral or bilateral implantation of the Molteno aqueous shunt (Molteno Ophthalmic). Patients who had undergone previous glaucoma surgery were excluded.

Patients underwent postop exams at 1 day, 14 days, and 1, 2 and 3 months. Subsequent examinations were conducted at least every 3 or 4 months, depending on the severity of inflammation. The mean follow-up interval was 59.3 months.

Mean preoperative logMAR visual acuity was 0.7. Mean preoperative IOP was 32.8 mm Hg, and mean number of medications was 3.1.

Postoperatively, mean IOP decreased to 17.7 mm Hg at 3 months and 15 mm Hg at 6 months. The decreases from baseline to 3 months and from 3 months to 6 months were statistically significant (P < .001 and P = .048, respectively).

The mean number of medications decreased to 1.9 at 3 months; the decrease was statistically significant (P < .001). Mean number of medications further decreased to 1.4 at 6 months (P = .013) and 1.1 at 1 year (P = .009).

Complete success was achieved in 40% of patients at 1 year, 50% at 2 years, 47% at 3 years and 39% at 4 years.

"It is suggested that it may be possible to postpone further surgical intervention during the first postoperative year after Molteno implantation even if the IOP is not quite optimal," the authors said.

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