Abstract

SO.20.10

Filtering glaucoma surgery in juvenile uveitis patients

Heinz C., Koch J., Heiligenhaus A.
Department of Ophthalmology at St. Franziskus-Hospital Münster

Objective: Surgical treatment of juvenile uveitic secondary glaucoma is often unsatisfactory due to increased scarring and aphakia of the patients. Aim of this study was to compare success rates of two sclera-incision techniques of glaucoma surgery. Lowering of IOP, reduction of glaucoma medication, complications and further surgery were analysed.
Methods: Monocenter retrospective analysis of 21 patients (24 operated eyes) with secondary glaucoma due to noninfectious uveitis before the age of 16. Overall, 20 eyes with anterior uveitis associated with JIA, and 4 eyes with intermediate uveitis had trabeculectomy (TE) with intraoperative mitomycin C (MMC) or a modified deep sclerectomy (mSR) with MMC and trabeculotomy.
Results: Overall, 21 children (17 girls) aged 12.7 SD 3.8 years were operated. Follow-up was 12.8 SD 9.2 months. A total of 16 TE (11 phakic, 2 pseudophakic and, 3 aphakic eyes) and 8 mSR (1 phakic, 2 pseudophakic, 5 aphakic) were performed. Intraocular pressure was preoperatively 28.3 SD 5.7 mmHg in the TE group, and 30.3 SD 6.3 mmHg (p=0,44) in the mSR group. Postoperative a reduction to 11.5 SD 5.5 mmHg in the TE group (mSR 14.9 SD 9.4 mmHg, p=0.27) was achieved. Topical therapy could be reduced from preoperative 3.3 SD 0.6 (mSR: 3.4 SD 0.9, p=0.84) to 0.13 SD 0.4 (mSR: 1.0 SD 1.4, p=0,035) drugs in the TE group. In the TE group, 14 (mSR: 5) successes, no (mSR: 1) limited success and in both groups two failures were observed. In the group of the aphakic children, 2 (mSR: 4) successes and one failure (mSR: 0) were found in the TE group. Ocular hypotension was present in 44% (mSR: 12%) of the TE group. Additional surgery (reduction of the filtering bleb/ needling) to regulate the IOP was necessary in 38% (mSR: 25%) in the TE group.
Conclusions: Both surgical techniques showed a marked reduction of IOP. The reduction of topical medication is superior in the TE group. Additional surgery and postoperative hypotony is more frequent in the TE group. In the group of aphakic patients, mSR seems to be the safe method.

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