The Effect of Perioperative Uveitis Control on the Success of Glaucoma Surgery in Uveitic Glaucoma

Abstract

Purpose

To study the effects of perioperative uveitis control (PUC) on postoperative intraocular pressure (IOP) and uveitis activity in uveitic glaucoma (UG) patients who required glaucoma surgeries.

Patients and Methods

A retrospective chart review of 109 patients (120 eyes) which had glaucoma surgery for UG. A total of 66 eyes which had PUC were compared to 54 eyes which did not have. Measurements of IOP and uveitis activity were recorded preoperatively and over 2 years postoperatively. Average number of antiglaucoma medications and frequency of surgical failure were obtained in both groups.

Results

Over 2 years postoperatively, average IOP was lower in eyes which had PUC. Significant differences in IOP were found at 3 months (P = 0.004), 6 months (P = 0.001), 1 year (P < 0.001), and 2 years (P < 0.001). Lower grades of anterior chamber (AC) inflammation were found in eyes which had PUC. Significant differences were found at 1 month (P < 0.001), 3 months (P < 0.001) and 6 months (P = 0.001). Mean number of antiglaucoma medications at last visit was 0.7 ± 1.1 for eyes which had PUC and 2.6 ± 1.5 for eyes which did not have PUC (P < 0.001). Among eyes which had PUC, only two eyes required second glaucoma surgeries, while 16 eyes with no PUC required further glaucoma surgeries after 27.7 ± 12.5 months (P < 0.001).

Conclusion

Proper PUC in patients going for UG surgeries results in lower IOP levels and less AC inflammation over 2 years postoperatively. A comprehensive PUC regimen is needed for uveitic glaucoma patients going for surgeries.

Graphical abstract

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Keywords:

• perioperative uveitis control
• uveitic glaucoma
• glaucoma surgeries
• immunosuppressive therapy

Abbreviations

5FU, 5-fluorouracil; AC, anterior chamber; AGV, Ahmed glaucoma valve; ANOVA, analysis of variance; DS, deep sclerectomy; GDD, glaucoma drainage devices; HLA-B27, human leukocyte antigen- B27; IL-6, Interleukin-6; IL-8, interleukin-8; IOP, intraocular pressure; kg, kilogram; KKESH, King Khaled Eye Specialist Hospital; logMAR, logarithm of minimal angle of resolution; MCP-1, Monocyte Chemoattractant Protein-1; mg, milligram; MMC, mitomycin C; NSAID, nonsteroidal anti-inflammatory drops; PDGF, platelet-derived growth factors; PUC, perioperative uveitis control; SPSS, Statistical Package for Social Sciences; SUN, Standardization of Uveitis Nomenclature; TNF-α, tumor necrosis factor-alpha; UG, uveitic glaucoma; VA, visual acuity; VEGF, vascular endothelial growth factor; VKH, Vogt Koyanagi Harada disease.

Data Sharing Statement

The original data used to support the findings of this study are available from the corresponding authors upon request.

Ethical Statement

Patient consent to review their medical records was not required by the Institutional Review Board of KKESH because no identifiable data were obtained and all patient data are kept confidential.

Disclosure

The authors declare that they have no conflicts of interest for this work.

Additional information

Funding

There is no funding to report.