Goniotomy Effective for Childhood Uveitic Glaucoma

TOPLINE:

Goniotomy demonstrates effectiveness in managing intraocular pressure in childhood glaucoma secondary to chronic uveitis, with success rates maintained in the long term and no deterioration of inflammatory control immediately after the operation.

METHODOLOGY:

• Researchers conducted a retrospective chart review to assess the long-term outcomes of goniotomy in children with glaucoma secondary to noninfectious uveitis.
• They included 31 eyes from 21 patients aged
• Surgery was indicated for intraocular pressure exceeding 21 mmHg despite being on maximal intraocular pressure–lowering medications or progression of glaucoma with an open anterior chamber angle.
• Complete surgical success was defined as achieving an intraocular pressure between 6 mmHg and 21 mmHg without medications; qualified success was defined as achieving these pressure ranges with topical intraocular pressure–lowering medications. The mean duration of follow-up after goniotomy was 6.8 years.
• The secondary outcomes included visual acuity, control of intraocular pressure, uveitis activity, complications, and use of topical steroids and disease-modifying antirheumatic drugs.

TAKEAWAY:

• Qualified surgical success was achieved in 24 eyes at the most recent follow-up (mean reduction in intraocular pressure, 14.1 mm Hg; P 
• Postoperative intraocular pressure was significantly lower than preoperative intraocular pressure at all annual follow-up time intervals (P
• Medications to reduce intraocular pressure were needed for all eyes preoperatively vs five eyes (21%) at the postoperative follow-up, with a median of four and two topical agents required before and after surgery, respectively.
• No significant change in intraocular inflammation was noted immediately after the operation. Small postoperative hyphemas were noted in 26 of 31 eyes (83.9%) but cleared spontaneously over a few days.

IN PRACTICE:

“Goniotomy is a safe, quick and effective procedure to lower IOP [intraocular pressure] in children with noninfectious uveitic glaucoma,” the authors of the study wrote.“Goniotomy can be effectively supplemented with a second goniotomy on the same eye when necessary,” they added.

SOURCE:

This study was led by Tiki Ewing, MBBS, of the Department of Ophthalmology and Visual Sciences at the University of British Colombia in Vancouver, Canada. It was published online on January 21, 2025, in the Journal of Glaucoma.

LIMITATIONS:

The retrospective design of the study led to a loss of participants over time, affecting long-term follow-up data. Researchers could not thoroughly examine use patterns of topical steroids due to variations in the choice of medications, dosing regimens, and documentation gaps, making it challenging to differentiate between true uveitic glaucoma and steroid-responsive increases in intraocular pressure. Although visual field testing and optical coherence tomography data would have enhanced the assessment of disease severity and follow-up success, collecting such data proved difficult in the pediatric population.

DISCLOSURES:

This study did not receive any specific funding. No conflicts of interest were declared.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.