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TOPLINE:

Goniotomy demonstrates effectiveness in managing intraocular pressure [IOP] in childhood glaucoma secondary to chronic uveitis, with success rates maintained in the long term and no deterioration of inflammatory control immediately after the operation.

METHODOLOGY:

• Researchers conducted a retrospective chart review to assess the long-term outcomes of goniotomy in children with glaucoma secondary to noninfectious uveitis.
• They included 31 eyes from 21 patients aged < 16 years (71% girls) who were diagnosed with noninfectious pediatric uveitis (mean age at the time of uveitis development, 6.3 years) and underwent goniotomy at a children’s hospital between January 2001 and March 2023 (mean age at first goniotomy, 10.25 years).
• Surgery was indicated for IOP exceeding 21 mmHg despite being on maximal IOP-lowering medications or progression of glaucoma with an open anterior chamber angle.
• Complete surgical success was defined as achieving an IOP between 6 mmHg and 21 mmHg without medications; qualified success was defined as achieving these pressure ranges with topical IOP-lowering medications. The mean duration of follow-up after goniotomy was 6.8 years.
• The secondary outcomes included visual acuity, control of IOP, uveitis activity, complications, and use of topical steroids and disease-modifying antirheumatic drugs.

TAKEAWAY:

• Qualified surgical success was achieved in 24 eyes at the most recent follow-up (mean reduction in IOP, 14.1 mm Hg; P < .001). A single goniotomy was successful in 19 eyes; however, 10 eyes underwent a second procedure.
• Postoperative IOP was significantly lower than preoperative IOP at all annual follow-up time intervals (P < .001) assessed over 8 years.
• Medications to reduce IOP were needed for all eyes preoperatively vs five eyes (21%) at the postoperative follow-up, with a median of four and two topical agents required before and after surgery, respectively.
• No significant change in intraocular inflammation was noted immediately after the operation. Small postoperative hyphemas were noted in 26 of 31 eyes (83.9%) but cleared spontaneously over a few days.

IN PRACTICE:

“Goniotomy is a safe, quick and effective procedure to lower IOP in children with noninfectious uveitic glaucoma,” the authors of the study wrote. “Goniotomy can be effectively supplemented with a second goniotomy on the same eye when necessary,” they added.

SOURCE:

This study was led by Tiki Ewing, MBBS, of the Department of Ophthalmology and Visual Sciences at the University of British Colombia in Vancouver, Canada. It was published online on January 21, 2025, in the Journal of Glaucoma.

LIMITATIONS:

The retrospective design of the study led to a loss of participants over time, affecting long-term follow-up data. Researchers could not thoroughly examine use patterns of topical steroids due to variations in the choice of medications, dosing regimens, and documentation gaps, making it challenging to differentiate between true uveitic glaucoma and steroid-responsive increases in IOP. Although visual field testing and optical coherence tomography data would have enhanced the assessment of disease severity and follow-up success, collecting such data proved difficult in the pediatric population.

DISCLOSURES:

This study did not receive any specific funding. No conflicts of interest were declared.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.