Purpose

The management of pediatric uveitis has evolved tremendously over the past decade with the introduction of new systemic, non-steroid treatments. The aim of this study was to evaluate the safety and efficacy of a goniotomy in this new treatment era.

Methods

Children with non-infectious uveitic glaucoma, who underwent a goniotomy procedure before their 18th birthday between 2011 and 2020 and had a follow-up of at least 1 year, were retrospectively included from the ophthalmology departments of the University Medical Centers of Amsterdam and Groningen. The primary outcomes were intraocular pressure (IOP), number of IOP-lowering medications, and success rates. Secondary outcomes included complications, uveitis activity, and visual acuity. Complete success was defined as IOP ≤ 21 mmHg after one or two goniotomies, without serious complications, the need for alternative glaucoma surgery, or IOP-lowering medication. Qualified success was defined similarly except for the use of IOP-lowering medication.

Results

Fifteen goniotomies were performed on 15 eyes of 10 children. The median age at goniotomy was 7 years and the median follow-up 49 months. The median IOP before surgery was 30 mmHg and the median number of IOP-lowering medications 4. After one goniotomy procedure, the IOP and use of IOP-lowering medication decreased significantly. Complete success was achieved in 9 eyes and qualified success in 4 eyes at the end of follow-up. Two eyes needed additional glaucoma surgery. Complications were mild and included transient hyphema in 1 eye and the need for cataract surgery in 2 eyes.

Conclusions

Goniotomy is a safe and effective surgery for children with uveitic glaucoma.