Gonioscopy-assisted transluminal trabeculotomy is an effective surgical treatment for uveitic glaucoma

BackgroundTo assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).MethodsA retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications.ResultsMean patient age (mean±SD) was 49±16 years (range: 18–79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up.ConclusionGATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.

Factors of Excessive Proliferation after Trabeculectomy in Pediatric Uveitic Glaucoma

Objective: to study efficacy and factors of excessive proliferation after trabeculectomy (T) in pediatric uveitic glaucoma (UG).Patients and Methods. 102 children aged from 3 to 17.5 years (mean 124.5 ± 2.8 month) with uncontrolled on maximum topical hypotensive therapy open angle or combined (with peripheral anterior synechiae) form of UG underwent T (148 eyes, 180 operations). 76.1 % operations were performed with intraoperative 5-fluorouracil, 8.3 % — with mitomycin C, 6.1 % — with bioresorbable, 1.7 % — with collagen drainage, 7.8 % — without antimetabolites or drainages. Kaplan-Meier survival analysis was performed.Results. Overall absolute (without hypotensive therapy) success probabilities were 67 %, 46 %, 39 %, qualified success (with hypotensive therapy) — 93 %, 72 %, 54 % at 1, 3, 5 years after T respectively. Factors associated with failure were primary location of inflammation in anterior uvea, aphakic or pseudophakic eye, repeat T, bioresorbable drainage (vs. 5-fluorouracil), persistent inflammation after T. Age and uveitis activity at the moment of T, duration hypotensive therapy before primary T, postoperative complications (9.4 %), frequency of postoperative topical steroid had no significant influence on surgical success.Conclusion. T with intraoperative antimetabolites is effective, safe and nowadays may be recommended as first choice operation in pediatric open angle or combined UG.

High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis

AimsTo examine presentation, management and long-term sequelae of ocular hypertension and uveitic glaucoma.MethodsRetrospective observational study of all subjects with uveitic glaucoma or ocular hypertension seen in Auckland uveitis clinics over the last 10 years.ResultsA total of 188 eyes of 139 subjects with uveitic glaucoma or ocular hypertension were included for analysis. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years. 52.5% of subjects were male. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median intraocular pressure (IOP) at diagnosis was 35 mm Hg (IQR 29–45). 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, 50 eyes underwent trabeculectomy, 18 eyes required a tube and 6 underwent minimally invasive glaucoma surgery.ConclusionRapid progression was observed from ocular hypertension to uveitic glaucoma. Uveitic glaucoma is aggressive, with high likelihood of requiring surgical management and high risk of central vision loss. Close collaboration between uveitis and glaucoma specialists is required to maximise outcomes for these patients.