Trabeculotomy in the Treatment of Pediatric Uveitic Glaucoma

To evaluate the efficacy and safety of trabeculotomy in the treatment of pediatric uveitic glaucoma (UG).

We retrospectively reviewed all cases that underwent trabeculotomy for pediatric UG at our center between 2008 and 2014. Up to 2 trabeculotomies per eye were performed in patients with medically controlled uveitis. Surgical success was defined as final intraocular pressure <22 mm Hg and ≥6 mm Hg after 1 or 2 trabeculotomies, with or without medications. Kaplan-Meier survival analyses were done.

A total of 33 trabeculotomies were performed in 28 eyes of 22 patients. Diagnoses included UG associated with juvenile idiopathic arthritis (68.2%), idiopathic uveitis (22.7%), and pars planitis (9.1%). The average age at surgery was 9.8±3.7 (5 to 17) years. With a mean follow-up of 33.6±18.3 (10 to 78) months, the overall surgical success was 81.8%. The cumulative survival probability after up to 2 trabeculotomies was 0.86 (95% confidence interval, 0.71-0.93) at 12 months and 0.77 (95% confidence interval, 0.60-0.87) at 24 months. Four (11.5%) eyes required a second trabeculotomy to achieve surgical success and 4 (7.7%) required filtrating procedures. Intraocular pressure improved from 31.4±7.6 (18 to 50) mm Hg preoperatively to 15.0±3.6 (8 to 23) mm Hg at final visits, whereas the number of glaucoma medications decreased from 4.2±1.1 (1 to 5) to 0.4±1.0 (0 to 4). Visual acuity and intraocular inflammation remained stable (P>0.05) and there were no major complications.

Trabeculotomy is a safe and effective surgery for pediatric UG.