Surgical treatment of secondary glaucoma in non-infectious pediatric uveitis

Secondary glaucoma in pediatric non-infectious uveitis is a very complex and
still potentially blinding disease. Blindness can be prevented in most cases with adequate controle of intraocular pressure (IOP), often requiring a surgical intervention. Known options for a surgical intervention include angle surgery (trabeculodialysis, goniotomy, or trabeculotomy), fistulizing procedures (trabeculectomy), glaucoma
drainage implant (GDI; Molteno GDI, Ahmed GDI, or Baerveldt GDI), or cyclophotocoagulation. In our review, all interventions are able to reduce IOP to an acceptable level, with cyclophotocoagulation having the shortest effect. In addition, the complication rate varies widely per intervention. We performed two studies to investigate the differences between interventions, focusing on the complication/re-intervention rate per intervention and thereby the impact of the overall treatment pathway, in order to identify an effective treatment pathway for these children with the least impact on the quality of life.

We retrospectively compared the outcomes of a trabeculectomy and a GDI procedure, and observed that GDIs had higher success rates, with a lower number of re-interventions. In addition, we retrospectively analyzing the outcomes of a goniotomy procedure in the current century, in which uveitis can be optimally controlled in most cases, thanks to the introduction of anti-TNF-alpha (a type of ‘biological’ (disease-modifying antirheumatic drug)). This study indicates that a goniotomy procedure is safe and straightforward, effective over a 5-year follow-up period, with an 86% success rate (which is superior compared to the other interventions), and might be considered as the best surgical options in these children.