Goniosurgery for Glaucoma Complicating Chronic Childhood Uveitis

OBJECTIVES To describe the safety and efficacy of goniotomy in medically uncontrolledglaucoma complicating chronic uveitis and the factors affecting its outcome. METHODS All goniotomies performed by a single surgeon for refractory childhooduveitic glaucoma were retrospectively reviewed. Success was defined as finalintraocular pressure (IOP) of no greater than 21 mm Hg without medicationsand qualified success as IOP of no greater than 21 mm Hg with medications.Unless otherwise indicated, data are expressed as mean ± SD. RESULTS Fifty-four goniotomies were performed in 40 eyes of 31 patients. Juvenilerheumatoid 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, 4-22years). Mean preoperative IOP was 36.7 ± 6.4 mm Hg while receivinga mean of 2.9 ± 1.1 medications. Overall surgical success was achievedin 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 postoperativeIOP in the success and qualified-success groups were 14.3 ± 2.8 and15.7 ± 3.1 mm Hg, 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 fewerperipheral anterior synechiae, patients younger than 10 years, and eyes withno prior surgery had significantly better outcomes. Hyphema, typically mildand transient, occurred in 43 procedures (80%). CONCLUSIONS Goniosurgery is low risk and effective for refractory glaucoma complicatingchronic childhood uveitis. It should be considered the surgical procedureof choice for this condition. Surgical outcome is adversely affected by increasedage, peripheral anterior synechiae, prior surgeries, and aphakia.Arch Ophthalmol. 2004;122:838-844-->