Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma

Leinonen, Sanna; Kotaniemi, Kaisu; Kivelä, Tero; Majander, Anna

doi:10.1001/jamaophthalmol.2015.3387

Cited by 7 publications

(7 citation statements)

References 32 publications

(44 reference statements)

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“…Three out of five studies on angle surgery describe a correlation of the outcomes with the presence of peripheral anterior synechiae, which is a sign of previous uncontrolled inflammation. After filtering surgery, Leinonen et al [ 28 ] described a significantly higher success rate in the TNFI group, which supports the theory that reduction of fibrosis postoperatively due to a more effective control of systemic inflammation could increase the IOP reduction and lower the risk of failure. The level of inflammation and its suppression by disease-modifying anti-rheumatic drugs (DMARDS) could be an important factor, related to the complications and ciliary body damage present before surgery [ 32 ] and for the survival of filtering blebs and the occurrence of fibrosis after filtering surgery [ 33 – 35 ].…”

Section: Discussionmentioning

confidence: 78%

“…In the fistulizing procedure studies, the success rate at 1 year after surgical intervention was 55–73%, at 2 years 39–88%, and at ≥ 5 years 16–73%. In a sub-analysis, Leinonen et al [ 28 ] described a significantly better outcome with the use of Tumor Necrosis Factor (TNF) inhibition. The use of TNF inhibition was not significantly associated with postoperative hypotony.…”

Section: Resultsmentioning

confidence: 99%

“…The use of TNF inhibition was not significantly associated with postoperative hypotony. No association was observed with any previous surgery on the operated eye [ 27 , 28 ]. Wiese [ 27 ] described no differences in outcomes in children with aphakic eyes as a subgroup, compared to the total study group ( n = 11 phakic/ n = 3 pseudophakic/ n = 7 aphakic).…”

Section: Resultsmentioning

confidence: 99%

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Uveitic glaucoma in children: a systematic review on surgical outcomes

Meerwijk

Jansonius

Los

2022

J Ophthal Inflamm Infect

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Purpose To compare the outcomes and complications of different surgical interventions for secondary glaucoma in pediatric uveitis. Methods Systematic review following the PRISMA standards. Main inclusion criteria were surgery for secondary glaucoma in pediatric uveitis at a mean age of 16 years or below, a mean follow-up period of at least 1 year after surgery, and at least 10 eyes per surgical intervention per study. We used the GRADE approach to assess study quality. Primary outcomes were intraocular pressure (IOP) and number of IOP lowering medications before and after surgery. Secondary outcomes were success rate and complications. Results Fourteen studies fulfilled the inclusion criteria, in which one (n = 11) or more (n = 3) surgical interventions were described, comprising in total six different procedures. According to the GRADE criteria, the quality of the studies was low to very low, in particular because of the small size and the applied study designs. All surgical interventions provided a significant decrease in IOP and number of IOP lowering medications. The success rates during follow-up varied widely, with the lowest rates of success after cyclophotocoagulation. The most frequently reported complications were ocular hypertension, hypotony, and hyphema, with an indication for a reoperation in more than one-third of the cases. Permanent vision loss was infrequently seen and was attributed to prolonged hypotony. Conclusions The described surgical interventions are able to prevent blindness by lowering a medically uncontrolled IOP to an acceptable level. Therefore, there is a crucial role for surgical intervention in these children. Based on the present studies, no preferences can be made. Given the reported complications, more research with larger sample sizes and direct comparisons is needed to determine the most successful glaucoma treatment in children with uveitis.

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Section: Discussionmentioning

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Uveitic glaucoma in children: a systematic review on surgical outcomes

Meerwijk

Jansonius

Los

2022

J Ophthal Inflamm Infect

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“…In the same vein, Leinonen et al. provide a retrospective analysis on the therapeutic potential of systemic TNF inhibitor on Mitomycin C-augmented trabeculectomy with juvenile idiopathic arthritis-related uveitic glaucoma patients ( 113 ). Data reported that the individuals treated with TNF inhibitors during Mitomycin C-augmented primary trabeculectomy have better control of IOP than those untreated.…”

Section: Potential Therapy Of Tnf/tnfr In Glaucomamentioning

confidence: 99%

Targeting Differential Roles of Tumor Necrosis Factor Receptors as a Therapeutic Strategy for Glaucoma

et al. 2022

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Glaucoma is an irreversible sight-threatening disorder primarily due to elevated intraocular pressure (IOP), leading to retinal ganglion cell (RGC) death by apoptosis with subsequent loss of optic nerve fibers. A considerable amount of empirical evidence has shown the significant association between tumor necrosis factor cytokine (TNF; TNFα) and glaucoma; however, the exact role of TNF in glaucoma progression remains unclear. Total inhibition of TNF against its receptors can cause side effects, although this is not the case when using selective inhibitors. In addition, TNF exerts its antithetic roles via stimulation of two receptors, TNF receptor I (TNFR1) and TNF receptor II (TNFR2). The pro-inflammatory responses and proapoptotic signaling pathways predominantly mediated through TNFR1, while neuroprotective and anti-apoptotic signals induced by TNFR2. In this review, we attempt to discuss the involvement of TNF receptors (TNFRs) and their signaling pathway in ocular tissues with focus on RGC and glial cells in glaucoma. This review also outlines the potential application TNFRs agonist and/or antagonists as neuroprotective strategy from a therapeutic standpoint. Taken together, a better understanding of the function of TNFRs may lead to the development of a treatment for glaucoma.

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“…The suitability of trabeculectomy specifically in JIA-related uveitic glaucoma was highlighted in a retrospective study of 21 children showing good IOP control and an overall success rate (with topical anti-glaucoma medication) of 71.4% after 5 years. 39 Leinonen et al 40 examined the results of the potential effect of treatment with systemic tumor necrosis factor (TNF) inhibitor on the success of an MMC-augmented trabeculectomy for individuals with JIA-related uveitic glaucoma. They reported that trabeculectomy success rates at 1, 5, and 10 years after surgery were higher among patients treated with TNF inhibitors (at the time of their trabeculectomy to control uveitis, arthritis, or both) when compared with those who were not treated with TNF inhibitors.…”

Section: Surgical Treament Of Glaucomamentioning

confidence: 99%

The Management of Uveitic Glaucoma in Children

Kalogeropoulos¹,

Kalogeropoulos²,

Moschos³

et al. 2019

tjo

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Children comprise a unique population of patients in regard to the diagnostic and therapeutic approach of uveitic glaucoma. The management of glaucoma secondary to uveitis in children is extremely challenging and presents various difficulties, which are associated both with the underlying uveitis and the young age of the patients. The treatment of uveitic glaucoma calls for a thorough and individualized approach, involving both pharmacotherapeutic and surgical modalities. It appears that the efficient control of inflammatory activity plays a significant role in the final visual outcome of these patients. This study aims to review the current literature about the management of uveitic glaucoma in pediatric patients.

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Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma

Cited by 7 publications

References 32 publications

Uveitic glaucoma in children: a systematic review on surgical outcomes

Uveitic glaucoma in children: a systematic review on surgical outcomes

Targeting Differential Roles of Tumor Necrosis Factor Receptors as a Therapeutic Strategy for Glaucoma

The Management of Uveitic Glaucoma in Children

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