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. 2023 Mar 12;12(6):2200.
doi: 10.3390/jcm12062200.

Goniotomy for Non-Infectious Uveitic Glaucoma in Children

Charlotte L L I van Meerwijk  1 , Astrid B Edema  1 , Laurentius J van Rijn  2 , Leonoor I Los  1 , Nomdo M Jansonius  1
Affiliations

Goniotomy for Non-Infectious Uveitic Glaucoma in Children

Charlotte L L I van Meerwijk et al. J Clin Med. .

Abstract

Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with pediatric uveitis receive biologics as immunosuppressive therapy for a prolonged period, with potential implications for the outcome. The purpose of the study is to evaluate the efficacy and safety of a goniotomy procedure in pediatric non-infectious uveitis in a retrospective, multicenter case series. The primary outcomes were the postoperative intraocular pressure (IOP), number of IOP-lowering medications, and success rate. Postoperative success was defined as 6 ≤ IOP ≤ 21 mmHg, without major complications or re-interventions. Fifteen eyes of ten children were included. Median age of the included patients at goniotomy was 7 years; median follow-up was 59 months. Median (interquartile range) IOP before surgery was 30 (26-34) mmHg with 4 (3-4) IOP-lowering medications. At 1, 2, and 5 years after goniotomy, median IOP was 15, 14, and 15 mmHg with 2 (0-2), 1 (0-2), and 0 (0-2) medications, respectively (p < 0.001 postoperatively versus preoperatively for all timepoints). Success rate was 100%, 93%, and 80% after 1, 2, and 5 years, respectively. There were no significant changes in visual acuity and uveitis activity or its treatment, and there were no major complications. Our results show that the goniotomy is an effective and safe surgery for children with uveitic glaucoma.

Keywords: childhood; glaucoma; surgery; uveitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Median intraocular pressure (IOP; gray bars) and median number of IOP-lowering medications (line) after one goniotomy procedure based on 15 eyes in 10 patients. Error bars depict interquartile range of the IOP.
Figure 2
Figure 2
Kaplan–Meier curve—cumulative survival after one goniotomy procedure in years. The number at risk is reported per year during the follow-up.
See this image and copyright information in PMC

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