Surgical Treatment of Complications of Uveitis
Complications of uveitis include band keratopathy, cataract, and glaucoma. Band keratopathy can be treated by removal of corneal epithelium, followed by calcium chelation with ethylenediaminetetraacetic acid (EDTA). Treatment may have to be repeated. Phototherapeutic keratectomy has also been used to treat band keratopathy.
Cataract surgery for patients with uveitis can be complicated by hypotony, glaucoma, synechiae formation, cystoid macular edema, and retinal detachment. In patients with JIA, combined lensectomy and vitrectomy seems to produce better results than cataract extraction alone. Uveitis must be aggressively treated so that it is under control both before and after surgery. Intraocular lens implantation is usually not considered in children with uveitis until after a prolonged period of quiescence.
Glaucoma surgery may become necessary in children with uveitis. Many techniques have been used, and long-term success rates vary. Standard trabeculectomy is associated with a high rate of failure due to scarring. Goniotomy or trabeculotomy is effective in many children and can be the initial surgery if the anterior chamber angle is visible. Tube shunts can be used when goniotomy fails or if the angle is closed.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.