June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Outcomes of minimally invasive glaucoma surgery in uveitic glaucoma
Author Affiliations & Notes
  • Andrew Philip
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Yujia Zhou
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Avery Zhou
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Andrew Dolinko
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Diana Morvey
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Maria Ruggeri
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
  • Amanda Collombo
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Anna Borelli
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
  • Priya Patel
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
  • Vallery Victor
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Kevin Boutouil
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
  • Peter Yuwei Chang
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • C Stephen Foster
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Stephen Anesi
    Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, United States
    Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Andrew Philip None; Yujia Zhou None; Avery Zhou None; Andrew Dolinko None; Diana Morvey None; Maria Ruggeri None; Amanda Collombo None; Anna Borelli None; Priya Patel None; Vallery Victor None; Kevin Boutouil None; Peter Chang None; C Stephen Foster None; Stephen Anesi None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 4276. doi:
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      Andrew Philip, Yujia Zhou, Avery Zhou, Andrew Dolinko, Diana Morvey, Maria Ruggeri, Amanda Collombo, Anna Borelli, Priya Patel, Vallery Victor, Kevin Boutouil, Peter Yuwei Chang, C Stephen Foster, Stephen Anesi; Outcomes of minimally invasive glaucoma surgery in uveitic glaucoma. Invest. Ophthalmol. Vis. Sci. 2023;64(8):4276.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The role of minimally invasive glaucoma surgery (MIGS) is unclear in the management of uveitic glaucoma, often felt to be contraindicated or insufficient. This retrospective study evaluates the outcomes of MIGS in uveitic glaucoma.

Methods : This is a retrospective single-site study including 32 eyes of 23 patients. All eyes had a diagnosis of uveitic glaucoma in remission at the time of MIGS. MIGS studied included canaloplasty, trabecular meshwork bypass, or gel stent filter. All MIGS were performed by a single surgeon (S.A.). Patients were excluded if they had less than 6 months followup after surgery or if topical or oral steroids had been used the month before surgery. Success was defined as a post-surgical decrease in intraocular pressure (IOP) ≥20% with final IOP between 6 and 21 mmHg or a decrease in IOP-lowering medications by at least 2. Failure included not meeting success criteria, later surgical intervention to manage IOP within 1 year, uveitis flare within 3 months after post-operative steroids, or topical steroid were extended beyond standard duration.

Results : Of 32 eyes, 12 (37.5%) had solely anterior uveitis, 11 (34.4%) panuveitis, and 9 (28.1%) posterior uveitis. Twelve (37.5%) eyes were quiescent without therapy, 11 (34.4%) were controlled with immunomodulatory therapy (IMT), 5 (15.6%) were controlled with intraocular steroid implants (IOSI) alone, and 4 (12.5%) required IMT and IOSI. Twenty-six eyes (81.3%) met all success criteria while 6 (18.8%) failed. Three eyes failed due to later surgical intervention, one did not meet IOP/medication criteria, one failed IOP/medication criteria and had later surgery, and one had a uveitis flare after topical steroid taper. Gel stent filter was the most common procedure, successful in 16/20 eyes (80%). Canaloplasty was successful in 8/9 eyes (88.9%) and trabecular meshwork bypass in 2/3 eyes (66.7%). Of 12 eyes with IOP > 21mmHg at time of MIGS, pre-surgical mean IOP was 28.4 ± 8.3 mmHg while on 3.4 ± 1.3 IOP-lowering medications. Post-surgical mean IOP was 14.8 ± 6.6 mmHg while on 1.0 ± 1.6 medications. Of 20 eyes with normal IOP at time of MIGS, pre-surgery mean IOP was 14.3 ± 4.0 mmHg on 3.1 ± 1.3 medications, and post-surgical average IOP was 13.3 ± 4.0 mmHg on 0.9 ± 1.0 medications.

Conclusions : MIGS can be successful in lowering IOP and/or reducing IOP-lowering medication burden in patients with uveitic glaucoma that is in remission.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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