EP180

Goniotomy for pediatric uveitic glaucoma

VAN MEERWIJK Charlotte EDEMA Astrid LOS Leonie VAN RIJN Renu00e9 JANSONIUS Nomdo

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.

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