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Tubes alleviate increased IOP in young patients with juvenile immune arthritis
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SAN FRANCISCO — Glaucoma can be blinding in young patients with juvenile immune arthritis, and although medical management is limited, surgical management with tube implantation can be somewhat successful, according to one presenter’s observations.
“I prefer valved tubes in these situations, mostly because of their predictability,” Joseph A. Caprioli, MD, said at the American Glaucoma Society annual meeting, adding that he prefers a rigid plate design rather than silicone. Potential problems include tube exposure due to erosion from steroids or eye rubbing, as well as iris adhesions.
Joseph A. Caprioli
Caprioli presented preliminary results from a study in which 33 eyes of 24 patients were implanted with Ahmed glaucoma valves (New World Medical). For 20 eyes for which results were available at 5 years’ follow-up, IOP averaged 12.8 mm Hg. Average preoperative IOP for all patients was 28.5 mm Hg.
Complications included corneal decompensation in one patient and shallow anterior chamber in six patients, although this resolved without further surgical intervention. Iris retraction at the base of the tube might be avoided by keeping the entrance of the tube away from the base of the iris, he said. Tubes eroded in four patients, necessitating surgical correction.
The surgical intervention was deemed successful in 94% of cases at 1 year and in 90% of 20 eyes at 5 years, Caprioli said.
“Tubes work pretty well,” he said. “Be careful of erosion and corneal decompensation, depending on the placement and the way the tube is covered.”
Disclosure: Caprioli has no relevant financial disclosures.