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Goniosurgery for glaucoma complicating chronic childhood uveitis
Ching Lin Ho1, Edmund Y M Wong, David S Walton
1Singapore National Eye Center, Singapore. hocl8@yahoo.com.sg
Archives of Ophthalmology (Chicago, Ill. : 1960)
|June 16, 2004
Summary
Goniotomy is a safe and effective surgical option for children with uncontrolled glaucoma due to chronic uveitis. Factors like younger age and fewer prior surgeries improve outcomes.
Area of Science:
- Ophthalmology
- Pediatric Glaucoma
- Uveitis Management
Background:
- Glaucoma complicating chronic uveitis in children presents a significant management challenge.
- Refractory cases often require surgical intervention to control intraocular pressure (IOP).
Purpose of the Study:
- To evaluate the safety and efficacy of goniotomy for medically uncontrolled glaucoma in pediatric uveitis.
- To identify factors influencing the success of goniotomy in this patient population.
Main Methods:
- Retrospective review of goniotomies performed by a single surgeon in pediatric patients with refractory uveitic glaucoma.
- Success defined as final IOP ≤ 21 mm Hg (with or without medications); qualified success as IOP ≤ 21 mm Hg with medications.
- Kaplan-Meier survival analysis was used to assess long-term outcomes.
Main Results:
- 72% overall surgical success (55% complete success, 18% qualified success) in 40 eyes over a mean follow-up of 98.9 months.
- Mean preoperative IOP of 36.7 mm Hg reduced significantly postoperatively.
- Favorable outcomes were associated with younger age (<10 years), phakic status, fewer peripheral anterior synechiae, and no prior surgery.
Conclusions:
- Goniotomy is a low-risk, effective surgical treatment for refractory glaucoma secondary to chronic childhood uveitis.
- It should be considered a primary surgical choice for this condition.
- Age, peripheral anterior synechiae, prior surgeries, and aphakia negatively impact surgical outcomes.