Trabeculectomy in Children with Juvenile Idiopathic Arthritis (JIA)–Associated Uveitic Glaucoma

Abstract

Abstract: : Purpose: To describe outcomes of trabeculectomy with anti–metabolites in children with Juvenile Idiopathic Arthritis (JIA)–associated uveitis. Methods: Retrospective review of patients 14 years or younger with JIA–associated uveitic glaucoma who underwent trabeculectomy with or without phacoemulsification cataract surgery with posterior chamber intraocular lens implantation (CE/PC–IOL) between January 1996 and June 2002. Patients underwent trabeculectomy when the intraocular pressure (IOP) was greater than 28 mm Hg on maximal medical therapy and cataract surgery when the best corrected vision was 20/100 or less. Results: Eight children (7 female, 1 male) with a median age of 10 years at the time of surgery were included in this study. Ten eyes underwent trabeculectomy with anti–metabolite (2 children had bilateral surgery and 3 eyes had CE/PC–IOL at the time of trabeculectomy surgery). Median duration of uveitis before glaucoma surgery was 3.1 years. Seven of eight children were on systemic immunosuppression for an average of 2.4 years before surgery. All patients received intensive and prolonged post–operative topical corticosteroid and immunosuppressive therapy. Seven of 10 eyes had surgical success; five of 10 eyes had complete success defined as IOP<22 mm Hg without medications. Three eyes failed (failure is defined as IOP>21 mm Hg with topical medications). Pre–operative median IOP was 34 mm Hg compared to the post–operative median IOP of 15.5 mm. All 3 eyes that underwent combined trabeculectomy and CE/PC–IOL had final vision > 20/25. Conclusions: Trabeculectomy surgery can be successful in patients with JIA–associated uveitis with appropriate patient selection and adequate pre– and post–operative control of inflammation.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • uveitis–clinical/animal model • intraocular pressure