MAY 18, 2016
Glaucoma, Uveitis
This retrospective study found that inflammation control with tumor necrosis factor (TNF) inhibitors improves outcomes of trabeculectomy with mitomycin C in patients with juvenile idiopathic arthritis (JIA)-related uveitic glaucoma.
This study underscores the importance of controlling ocular inflammation during the perioperative period since uncontrolled inflammation can lead to scarring and surgical failure, especially in young patients.
In this study, the authors identified 29 patients (29 eyes) with JIA-uveitis who had undergone trabeculecomy with mitomycin C between 1996 and 2014. Over a mean follow-up time of almost 8 years, TNF inhibitor-treated eyes had longer surviving trabeculectomies (3.2 vs. 1.2 years, P=0.14) and a steady surgical success rate of 73% at 1, 5 and 10 years, with success defined as IOP of ≤21 mm Hg without antiglaucomatous medication or additional surgery.
The success rate was even higher for patients with no prior history of ocular surgery (83%). Incontrast, patients not treated with TNF-inhibitors showed a steady decline in the overall success rate from 57% at 1 year to 16% at 5 years and 0% at 10 years.
Unfortunately, trabeculectomy often fails in children even when inflammation is adequately controlled. Glaucoma drainage devices (GDD) are another option in this population at high risk for permanent vision loss. A recent study showed that young patients with uveitic glaucoma have greater success with GDDs compared to other types of pediatric glaucoma.