Uveitic glaucoma in children: a systematic review on surgical outcomes

Abstract

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.

Goniotomy for Non-Infectious Uveitic Glaucoma in Children

“…Cataract progressed in only a few cases after goniotomy. The complication profile of the goniotomy procedure is mild when compared to that of TE and glaucoma drainage implants, which have a risk of hypotony and bleb or implant-based complications [ 10 ].…”

“…Another option is goniotomy. Previous research and a recent review showed no preference for a particular intervention [ 9 , 10 ]. Advantages of goniotomy over the other two types of intervention are a quick surgical procedure and a relatively rapid postoperative recovery.…”