Secondary glaucoma in pediatric non-infectious uveitis is a very complex and still potentially blinding disease. Blindness can be prevented in most cases with adequate controle of intraocular pressure (IOP), often requiring a surgical intervention. Known options for a surgical intervention include angle surgery (trabeculodialysis, goniotomy, or trabeculotomy), fistulizing procedures (trabeculectomy), glaucoma drainage implant (GDI; Molteno GDI, Ahmed GDI, or Baerveldt GDI), or cyclophotocoagulation.
In this thesis of Charlotte van Meerwijk, all interventions are able to reduce IOP to an acceptable level, with cyclophotocoagulation having the shortest effect. In addition, the complication rate varies widely per intervention. We performed two studies to investigate the differences between interventions, focusing on the complication/re-intervention rate per intervention and thereby the impact of the overall treatment pathway, in order to identify an effective treatment pathway for these children with the least impact on the quality of life.
We retrospectively compared the outcomes of a trabeculectomy and a GDI procedure, and observed that GDIs had higher success rates, with a lower number of re-interventions. Additionally, we reviewed the results of a goniotomy procedure in recent years. Uveitis can usually be well-treated with the introduction of anti-TNF-alpha (a type of ‘biological’ (disease-modifying antirheumatic drug).
This study indicates that a goniotomy procedure is safe and straightforward, effective over a 5-year follow-up period, with an 86% success rate (which is superior compared to the other interventions), and might be considered as the best surgical options in these children.
