Goniotomy effective first-line treatment for pediatric refractory glaucoma

DURHAM, N.C. — Goniotomy is safe and effective as a first-line treatment for young patients with refractory glaucoma associated with chronic uveitis, according to a long-term study here. Most patients require glaucoma medication after the procedure, the study found.

Sharon Freedman, MD, and colleagues here at Duke University Eye Center reviewed the records of 19 goniotomies on 16 eyes of 12 patients with refractory glaucoma associated with chronic childhood uveitis. The mean patient age was 15 years at the first goniotomy, with a mean follow-up of 32 months.

Uveitis was medically controlled for 6 weeks before surgery. Success was defined as final intraocular pressure of 21 mm Hg or less after one or two goniotomies without the need for further surgical intervention. Follow up was at least 6 months or until surgical failure.

Diagnoses included uveitic glaucoma associated with juvenile rheumatoid arthritis, sarcoidosis and idiopathic uveitis.

Mean preoperative IOP was 32 mm Hg. Surgical success was achieved in 75% of eyes, with a mean postoperative IOP of 12 mm Hg (P < .0001). In 10 of the eyes (60%), surgical success was achieved after a single goniotomy. Uveitis was stable in all patients after the early postop period. Successful eyes used, on average, 1.4 glaucoma medications after goniotomy.

Complications were mild; they included transient hyphema in nine cases and worsening of an existing cataract in one case.

The study is published in the American Journal of Ophthalmology.