Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital

Nestor Ventura-Abreu; Joana Mendes-Pereira; Marta Pazos; Ma Jesús Muniesa-Royo; Andrea Gonzalez-Ventosa; Barbara Romero-Nuñez; Elena Milla

doi:10.5005/jp-journals-10078-1306

Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital

J Curr Glaucoma Pract. 2021 May-Aug;15(2):52-57. doi: 10.5005/jp-journals-10078-1306.

Authors

Nestor Ventura-Abreu¹, Joana Mendes-Pereira², Marta Pazos¹, Ma Jesús Muniesa-Royo¹, Andrea Gonzalez-Ventosa¹, Barbara Romero-Nuñez¹, Elena Milla³

Affiliations

¹ Department of Ophthalmology, Hospital Clinic, Barcelona, Catalonia, Spain.
² Department of Ophthalmology, Leiria Hospital Centre, Leiria, Portugal.
³ Department of Ophthalmology, Hospital Clinic de Barcelona, Innove Ocular-ICO Barcelona, Spain.

Abstract

Aim and objective: This study aimed to evaluate the performance of and indication for different surgical techniques in the management of uveitic glaucoma (UG).

Materials and methods: A retrospective audit of records of all patients with UG who underwent ≥1 glaucoma surgery, between January 2007 and December 2016. The main outcomes were intraocular pressure (IOP) and the need for antihypertensive medication at each follow-up visit. The total number of surgical interventions needed to control IOP was recorded. Postoperative interventions and complications were analyzed.

Results: Forty eyes from 34 patients were assessed. Overall, baseline IOP was 30.7 ± 8.2 mm Hg, and postoperative mean IOP at the last visit was 16.4 ± 2.0 mm Hg, with a mean follow-up of 28 months. Antihypertensive medications were reduced from 2.8 ± 0.8 to 0.8 ± 1.2. During the follow-up, 61.8% of the eyes required only one glaucoma surgery. There was no correlation between the location of uveitis and the total number of glaucoma surgeries required. The greatest IOP reductions were in cases treated with non-penetrating deep sclerectomy (21%), Ahmed valve (23%), and cyclophotocoagulation (CPC) (51%); in cases where an Ahmed implant was the first surgical option, a 43% reduction was achieved.

Conclusion: Filtering procedures, glaucoma drainage devices, and CPC are all good options for IOP control in UG, but all are prone to failure over time. With respect to IOP reduction, the safety profile, and postoperative care, Ahmed implants and CPC might be the best first surgical option.

Clinical significance: The article highlights the versatility of the surgical techniques required to treat UG, which is one of the most difficult types of glaucoma to manage.

How to cite this article: Ventura-Abreu N, Mendes-Pereira J, Pazos M, et al. Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital. J Curr Glaucoma Pract 2021;15(2):52-57.

Keywords: Glaucoma filtering surgery; Implant drainage devices; Uveitic glaucoma.