Effect of Uveitis Activity on Surgical Outcomes in Uveitic Glaucoma

Abstract

Purpose : Surgical treatment in managing uveitic glaucoma is often difficult due to its complex balance between inflammation and intraocular pressure control. We have conducted a retrospective study to examine surgical outcomes of trabeculectomy and glaucoma drainage implant (GDI) surgery in uveitic glaucoma. In particular, we examined the effect of uveitic activity at the time of surgery or following surgery on surgical outcomes.

Methods : Retrospective chart review of 82 consecutive cases with uveitic glaucoma who underwent either trabeculectomy or GDI surgery between 2006 and 2014 at Royal Victorian Eye and Ear Hospital. Primary outcome measures were based on conesnsus definition from World Glaucoma Association.

Results : 54 eyes underwent trabeculectomies and 28 eyes underwent GDI surgery, of which 12 were primary GDIs. Mean age of patients was 50 ±2.35 (8-85) years. Follow up duration was 25.1±2.33 (3-125) months.
37% trabeculectomies and 57.1% GDIs had anterior uveitis. 65.9% trabeculectomies and 34.1% GDIs were steroid responders. All trabeculectomies were performed with an antimetabolite. In GDIs, 21 had Baerveldt tubes and 7 had Molteno tubes. At final follow up, similar Qualified Success rate was observed in trabeculectomies (64.8%) and in GDIs (64.2%). No significant difference was observed between Primary and secondary GDIs (58.3 vs 68.8%, p= 0.70). A higher rate of Absoulte Success was achieved in trabeculectomies (48.1% trabs vs 21.4% GDIs, p=0.03). 35.2% of trabeculectomies and 3.5% of GDIs had active uveitis at the time of surgery(p<0.01). Uveitic activity at the time of surgery was not associated with increased risk of failure in our trabeculectomy group (p=0.91). Overall, uveitis flare up was observed in 43.9% of all cases following surgery. In trabeculectomies, there was a trend for decreased success rate in those who had uveitis flare up. 60% of those with flare up compared to 85.7% of those without flare up achieved Qualified Success, although not reaching statistical significance (p=0.16). Similar but lesser trend was also observed in GDIs, 54.5% with flare up compared to 71.4% without flare up achieved Qualified Success (p=0.64).

Conclusions : No significant difference in success rate between trabeculectomies and GDIs in management of uveitic glaucoma in this series. Good control of post operative uveitis activity should be considered to ensure success of glaucoma surgery for uveitic glaucoma.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.