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Robert Purgert, Careen Lowder, Jonathan Eisengart; Minimally invasive glaucoma surgery efficacy in uveitic and steroid-induced glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3739.
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© ARVO (1962-2015); The Authors (2016-present)
Outcomes of minimally invasive glaucoma surgery (MIGS) devices are well-described for primary open angle glaucoma, but more limited data is available for other glaucoma types. We sought to elucidate the effectiveness of two MIGS devices, gonioscopy assisted transluminal trabeculotomy (GATT) and Kahook dual blade (KDB), in uveitic and steroid-induced glaucoma.
Medical records of patients undergoing GATT or KDB surgery by a single surgeon at Cleveland Clinic since 2015 were retrospectively reviewed. Individuals were included if they were ≥ 18 years old with uveitic and/or steroid-induced glaucoma with uncontrolled intraocular pressure (IOP). Paired and unpaired t-tests were used for within- and between-subject comparisons, respectively.
21 eyes from 18 consecutive patients were identified. 3 eyes were excluded (2 for iatrogenic cyclodialysis with hypotony, 1 for MIGS treatment failure requiring reoperation for IOP control). Age was 47 ± 17 years (range 18-74). Gender was 66% female. Efficacy at 6 months for each glaucoma type was as follows. Steroid-induced glaucoma patients had IOP reduction of 19.0 ± 6.0 mmHg (n=4, p=0.019) and reduction of 3.0 ± 0.4 medications (n=4, p=0.0003). Uveitic glaucoma patients had IOP reduction of 9.5 ± 5.2 mmHg (n=4, p=0.12) and reduction of 1.8 ± 1.0 medications (n=4, p=0.14) that approached statistical significance. Patients with both steroid + uveitic glaucoma had IOP reduction of 11.9 ± 3.5 mmHg (n=10, p=0.003) and reduction of 2.1 ± 0.5 medications (n=10, p=0.0006). Efficacy at 6 months for each MIGS device was as follows. Patients that underwent KDB had IOP reduction of 8.4 ± 2.9 mmHg (n=8, p=0.013) and reduction of 1.8 ± 0.6 medications (n=8, p=0.007). Patients that underwent GATT had IOP reduction of 16.6 ± 3.7 mmHg (n=10, p=0.0003) and reduction of 2.6 ± 0.5 medications (n=10, p=0.0001). Efficacy at 6 months for all patients cumulatively was as follows. There was IOP reduction of 12.9 ± 2.6 mmHg (n=18, p=0.0001) and reduction of 2.2 ± 0.4 medications (n=18, p=0.0001). There was no statistically significant difference in efficacy between the types of glaucoma or MIGS devices.
Uveitic and steroid-induced glaucoma can be effectively managed with GATT and KDB. Both achieve approximately 10 mmHg IOP reduction and elimination of 1-2 glaucoma medications. This study helps elucidate glaucoma types that can be effectively managed with MIGS devices.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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