Surgical outcomes can be successful in refractory uveitic glaucoma in children

Brenda L. Bohnsack

SAN ANTONIO — One of the main causes of uveitis is glaucoma, and goniotomy or drainage device implantation can successfully manage pediatric cases that are refractory to medical management and preserve vision, a presenter said here.

"Goniotomy is a safe and short procedure, but it does require surgeon expertise for a gonioscopic view of the angle. Glaucoma drainage devices can be used in both adults and children; however, they can cause early hypotony, anterior segment changes, and may require additional surgeries for either exposures or repositioning of the tube," Brenda L. Bohnsack, MD, PhD, said at the American Association for Pediatric Ophthalmology and Strabismus meeting.

Trabeculectomy, which is often used in adults, is less successful in children, she said.

In a retrospective chart review of 36 eyes in 36 patients younger than 18 years of age with uveitic glaucoma, Dr. Bohnsack and colleagues set out to evaluate their surgical methods in these cases. Success was defined as IOP less than 21 mm Hg, clinically stable state and no need for additional IOP-lowering surgery.

Of the 36 patients, 31 underwent goniotomy and five were implanted with a drainage device.

At last follow-up, 33 of 36 eyes showed IOP less than 21 mm Hg and preservation of preoperative vision. One eye had IOP in the mid-20s on no glaucoma medications. Two eyes had significant complications: traumatic retinal detachment not related to surgery and uncontrolled ocular and systemic inflammation due to noncompliance, with subsequent phthisis.

"In our hands, goniotomy is our first line of surgical treatment," Dr. Bohnsack said. "This is especially true if the angle is open."

Disclosure: Dr. Bohnsack has no relevant financial disclosures.