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Abstract #10674 Published in IGR 6-2
Goniosurgery for glaucoma complicating chronic childhood uveitis
Ho CL; Wong EY; Walton DSArchives of Ophthalmology 2004; 122: 838-44
OBJECTIVES: To describe the safety and efficacy of goniotomy in medically uncontrolled glaucoma complicating chronic uveitis and the factors affecting its outcome. METHODS: All goniotomies performed by a single surgeon for refractory childhood uveitic glaucoma were retrospectively reviewed. Success was defined as final intraocular pressure (IOP) of no greater than 21 mmHg without medications and qualified success as IOP of no greater than 21 mmHg with medications. Unless otherwise indicated, data are expressed as mean± SD. RESULTS: Fifty-four goniotomies were performed in 40 eyes of 31 patients. Juvenile rheumatoid arthritis-associated uveitis was the diagnosis in 30 eyes (75%). Eleven eyes (28%) were aphakic. Mean follow-up was 98.9 months (range, 2-324 months). Mean age at surgery was 10.3± 4.7 years (range, 4-22 years). Mean preoperative IOP was 36.7± 6.4 mmHg while receiving a mean of 2.9± 1.1 medications. Overall surgical success was achieved in 29 eyes (72%), including success in 22 (55%) and qualified success in 7 (18%) while receiving a mean of 1.6± 1.1 medications. Mean postoperative IOP in the success and qualified-success groups were 14.3± 2.8 and 15.7± 3.1 mmHg, respectively. Kaplan-Meier survival probabilities (95% confidence interval) at 1, 5, and 10 years were 0.92 (0.82-1.00), 0.81 (0.65-0.97), and 0.71 (0.49-0.92), respectively. Phakic eyes, eyes with fewer peripheral anterior synechiae, patients younger than 10 years, and eyes with no prior surgery had significantly better outcomes. Hyphema, typically mild and transient, occurred in 43 procedures (80%). CONCLUSIONS: Goniosurgery is low risk and effective for refractory glaucoma complicating chronic childhood uveitis. It should be considered the surgical procedure of choice for this condition. Surgical outcome is adversely affected by increased age, peripheral anterior synechiae, prior surgeries, and aphakia.
Singapore National Eye Center, Singapore. hocl8@yahoo.com.sg
Classification:
9.4.6 Glaucomas associated with inflammation, uveitis (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
12.9 Trabeculotomy, goniotomy (Part of: 12 Surgical treatment)