Goniotomy for Childhood Glaucoma Secondary to Uveitis: Long-Term Outcomes.

Abstract

Prcis: Goniotomy is effective in managing intraocular pressure in childhood glaucoma secondary to uveitis with a cumulative probability of success 0.94 after 1 year and 0.77 after 5 years.

Objective: To evaluate the long-term success of goniotomy for childhood glaucoma secondary to chronic uveitis.

Methods: Retrospective chart review of all children treated with goniotomy for this indication from 2001 to 2023. Postoperative success was defined as IOP ≥ 6 and ≤ 21 mmHg after 1 or 2 goniotomies, without the need for further surgical intervention or sight-threatening complication.

Results: Thirty-one eyes of 21 patients were included. The mean age at first goniotomy was 10.3 years (range 6.6-15.7 years) with uveitis diagnosed on average 4.7 years earlier. The mean preoperative IOP was 28.8 mmHg, on a median of 4 topical agents. Mean follow-up post-goniotomy was 6.8 years (Median 5.7 y) and average postoperative IOP at 1, 5, and 8 years postoperatively was 15.9, 15.2, and 15.6 mmHg, respectively. At the most recent follow-up, 24 eyes (77.4%) were a surgical success. Of these, 5 (21%) needed a second goniotomy to achieve this, and 5 (21%) needed anti-glaucoma drops to maintain IOP ≤21 mmHg (2 of these also had a second goniotomy). There were no major complications, including loss of inflammatory control.

Conclusion: We confirm that this quick, safe, conjunctival-sparing primary approach is safe and effective in this context, and early success rates are usually maintained in the long term. If stable inflammatory control can be achieved preoperatively, we recommend it as first-line treatment for children with childhood glaucoma secondary to uveitis.