Abstract
Purpose :
There is limited data regarding the role and efficacy of minimally invasive glaucoma surgery in the management of uveitic glaucoma (UG). We examined surgical outcomes in patients with UG after cataract extraction with lens implantation (CEIOL) plus endocyclophotocoagulation (ECP) or CEIOL plus OMNI™ ab-interno canaloplasty +/- trabeculotomy (Sight Sciences) (OMNI).
Methods :
All patients aged >18 years with UG who underwent CEIOL + ECP or CEIOL + OMNI between August 2019 and September 2021 at a single academic center with a single surgeon were retrospectively reviewed. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg or reduction from baseline by 20% for two consecutive visits, without hypotony (IOP ≤5 mmHg), additional glaucoma surgery, or loss of light perception. Uveitic control was defined as less than a two-step increase in anterior chamber (AC) cell or lack of increase in steroid drop frequency. Outcomes were measured at three months post-operatively.
Results :
Nine patients (14 eyes) were identified (eight ECP, six OMNI). Baseline pre-operative characteristics including IOP, AC cell grade, visual acuity (VA), age, sex, race, and affected eye(s) were not significantly different between groups. All cases were successful and had improved VA. In CEIOL + ECP and CEIOL + OMNI cases, IOP was reduced an average of 7.0 mmHg (p=0.06) and 8.9 (p=0.03) respectively. The number of glaucoma medications reduced by 0.3 (p=0.18) and 1.0 (p=0.04) respectively. Outcome differences between groups did not meet statistical significance. No cases had a two-step increase in AC cell, however there was an increase in steroid drop frequency for 50% of patients in each group. Post-surgical complications included cystoid macular edema (1/8 of ECP and 3/6 of OMNI cases), hyphema (2/6 of OMNI cases), and IOP spike (1/6 of OMNI cases).
Conclusions :
Both ECP and OMNI with CEIOL improved VA, IOP, and glaucoma medication use, without a two-step increase in AC cell in UG at three months. An increase in steroid drop frequency may be the cost of a prolonged post-surgical inflammatory course related to the underlying uveitis. Further investigation with a larger population, longer follow-up, and prospective design are necessary.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.