Citation Information :
Ventura-Abreu N, Mendes-Pereira J, Pazos M, Muniesa-Royo MJ, Gonzalez-Ventosa A, Romero-Nuñez B, Milla E. Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital. J Curr Glaucoma Pract 2021; 15 (2):52-57.
Aim and objective: This study aimed to evaluate the performance of and indication for different surgical techniques in the management of uveitic glaucoma (UG).
Materials and methods: A retrospective audit of records of all patients with UG who underwent ≥1 glaucoma surgery, between January 2007 and December 2016. The main outcomes were intraocular pressure (IOP) and the need for antihypertensive medication at each follow-up visit. The total number of surgical interventions needed to control IOP was recorded. Postoperative interventions and complications were analyzed.
Results: Forty eyes from 34 patients were assessed. Overall, baseline IOP was 30.7 ± 8.2 mm Hg, and postoperative mean IOP at the last visit was 16.4 ± 2.0 mm Hg, with a mean follow-up of 28 months. Antihypertensive medications were reduced from 2.8 ± 0.8 to 0.8 ± 1.2. During the follow-up, 61.8% of the eyes required only one glaucoma surgery. There was no correlation between the location of uveitis and the total number of glaucoma surgeries required. The greatest IOP reductions were in cases treated with non-penetrating deep sclerectomy (21%), Ahmed valve (23%), and cyclophotocoagulation (CPC) (51%); in cases where an Ahmed implant was the first surgical option, a 43% reduction was achieved.
Conclusion: Filtering procedures, glaucoma drainage devices, and CPC are all good options for IOP control in UG, but all are prone to failure over time. With respect to IOP reduction, the safety profile, and postoperative care, Ahmed implants and CPC might be the best first surgical option.
Clinical significance: The article highlights the versatility of the surgical techniques required to treat UG, which is one of the most difficult types of glaucoma to manage.
Jabs DA, Nussenblatt RB, Rosenbaum JT, et al. Standardization of uveitis nomenclature for reporting clinical data. Results of the first international workshop. Am J Ophthalmol 2005;140(3):509–516. DOI: 10.1016/j.ajo.2005.03.057.
Sherman ER, Cafiero-Chin M. Overcoming diagnostic and treatment challenges in uveitic glaucoma. Clin Exp Optom 2019;102(2):109–115. DOI: 10.1111/cxo.12811.
Arruabarrena C, Muñoz-Negrete FJ, Márquez C, et al. Resultados de la esclerectomia profunda no perforante en el tratamiento del glaucoma inflamatoria al año de seguimiento. Arch Soc Esp Oftalmol 2007;82(8):483–488. DOI: 10.4321/s0365-66912007000800006.
Al Obeidan SA, Osman EA, Mousa A, et al. Long-term evaluation of efficacy and safety of deep sclerectomy in uveitic glaucoma. Ocul Immunol Inflamm 2015;23(1):82–89. DOI: 10.3109/09273948.2013.870213.
Mercieca K, Steeples L, Anand N. Deep sclerectomy for uveitic glaucoma: long-term outcomes. Eye 2017;31(7):1008–1019. DOI: 10.1038/eye.2017.80.
Dupas B, Fardeau C, Cassoux N, et al. Deep sclerectomy and trabeculectomy in uveitic glaucoma. Eye 2010;24(2):310–314. DOI: 10.1038/eye.2009.82.
Dhanireddy S, Kombo NC, Payal AR, et al. The Ex-PRESS glaucoma filtration device implantation in uveitic glaucoma. Ocul Immunol Inflamm 2017;25(6):767–774. DOI: 10.1080/09273948.2016.1175639.
Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012;153(5):789–803. DOI: 10.1016/j.ajo.2011.10.026.
Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol 2012;153(5):804–814. DOI: 10.1016/j.ajo.2011.10.024.
Gedde SJ, Feuer WJ, Lim KS, et al. Treatment outcomes in the primary tube versus trabeculectomy (PTVT) study after 3 years of follow-up. Ophthalmology 2019;127(3):333–345. DOI: 10.1016/j.ophtha.2019.10.002.
Chow A, Burkemper B, Varma R, et al. Comparison of surgical outcomes of trabeculectomy, Ahmed shunt, and Baerveldt shunt in uveitic glaucoma. J Ophthalmic Inflamm Infect 2018;8(1):9. DOI: 10.1186/s12348-018-0150-y.
Iverson SM, Bhardwaj N, Shi W, et al. Surgical outcomes of inflammatory glaucoma: a comparison of trabeculectomy and glaucoma-drainage-device implantation. Jpn J Ophthalmol 2015;59(3):179–186. DOI: 10.1007/s10384-015-0372-6.
Bettis DI, Morshedi RG, Chaya C, et al. Trabeculectomy with Mitomycin C or Ahmed valve implantation in eyes with uveitic glaucoma. J Glaucoma 2015;24(8):591–599. DOI: 10.1097/IJG.0000000000000195.
Kramp K, Vick H-P, Guthoff R. Transscleral diode laser contact cyclophotocoagulation in the treatment of different glaucomas, also as primary surgery. Graefe's Arch Clin Exp Ophthalmol 2002;240(9):698–703. DOI: 10.1007/s00417-002-0508-5.
Pantalon AD, Barata ADDO, Georgopoulos M, et al. Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation. Br J Ophthalmol 2020;104(10):1378–1383. DOI: 10.1136/bjophthalmol-2019-315434.
Schlote T. Transscleral diode laser cyclophotocoagulation for the treatment of refractory glaucoma secondary to inflammatory eye diseases. Br J Ophthalmol 2000;84(9):999–1003. DOI: 10.1136/bjo.84.9.999.
Holló G, Schmidl D, Hommer A. Referral for first glaucoma surgery in Europe, the ReF-GS study. Eur J Ophthalmol 2019;29(4):406–416. DOI: 10.1177/1120672118791937.
Valenzuela RA, Flores I, Urrutia B, et al. New pharmacological strategies for the treatment of non-infectious uveitis. A minireview. Front Pharmacol 2020;11(8):1–8. DOI: doi.org/10.3389/fphar.2020.00655.