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

Precis: Goniotomy is effective in managing intraocular pressure in childhood glaucoma secondary to uveitis with 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. Post operative 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: 31 eyes of 21 patients were included. Mean age at first goniotomy was 10.3 years (range 6.6- 15.7 years) with uveitis diagnosed on average 4.7 years earlier. Mean pre-operative IOP was 28.8 mmHg, on a median of 4 topical agents. Mean follow-up post-goniotomy was 6.8 years (Median 5.7 years) and average post operative IOP at 1, 5 and 8 years post-operatively was 15.9, 15.2 and 15.6 mmHg respectively. At 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 (two of these were cases who also underwent 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 pre-operatively, we recommend it as first line treatment for children with childhood glaucoma secondary to uveitis.