Factors Associated With Glaucoma Surgery in Pediatric Non-Infectious Uveitis

Figures & data

Table 1. Characteristics at presentation.

	Total (n = 185)	Glaucoma surgery (cases, n = 84)	No glaucoma surgery (controls, n = 101)	P-value
Center 1^a	88 (48%)	34	54
Center 2^b	97 (52%)	50	47
Age at uveitis onset (years)^c	7 (4-10)	6 (4-9)	7 (5-11)	0.06
Sex – female	111 (60%)	53	58	0.43
Bilateral disease	129 (70%)	56	73	0.41
Anatomic location uveitis				0.06
- Anterior	134 (72%)	66	68
- Intermediate	21 (11%)	6	15
- Posterior	5 (3%)	0	5
- Panuveitis	25 (14%)	12	13
LogMAR^d visual acuity at presentation^a	0.22 (0.01 to 0.60)	0.19 (0.02 to 0.58)	0.22 (0.00 to 0.70)	0.71
IOP^e measurement at presentation (mmHg)^c	17 (14 - 18)	17 (14 - 21)	17 (14 - 18)	0.23
Ocular complications				0.17
- No complications	54 (29%)	24	30
-Anterior segmentcomplications^f	64 (35%)	36	28
- Posterior segment complications^g	29 (16%)	10	19
Anterior and posterior segment complications	36 (20%)	14	22
Etiology				0.002
- Unknown	81 (44%)	28	53
- JIA^h	92 (50%)	53	39
- HLA-B27	6 (3%)	3	3
- Other auto-immune	6 (3%)	0	6
ANA^iseropositive	103 (56%)	53	50	0.15
Treatment with systemic DMARDs^j at presentation	110 (60%)	41	69	0.007
Systemic steroids at presentation	70 (38%)	23	47	0.007
- Presentation before 2000 (N = 26)	8	3	5	0.17
- Presentation between 2000-2010 (N = 91)	29	10	19	0.01
- Presentation after 2010 (N = 68)	33	10	23	0.82
Systemic csDMARDs^k at presentation	65 (35%)	29	36	0.87
- Presentation before 2000	4	3	1	0.45
- Presentation between 2000-2010	29	19	10	0.13
- Presentation after 2010	32	7	25	0.20
Systemic bDMARDs^l at presentation	2 (1%)	0	2	0.20
- Presentation before 2000	0	0	0	n/a
- Presentation between 2000-2010	0	0	0	n/a
- Presentation after 2010	2	0	2	0.34

^aCenter 1 = University Medical Center Groningen, ^bCenter 2 = University Medical Center Utrecht, ^cMedian (interquartile range ^dlogarithm of the minimum angle of resolution, ^eIOP = intraocular pressure, ^fanterior complications at presentation: band keratopathy, cataract, posterior synechiae, ^gposterior complications at presentation: macular edema, papillitis, ^hJuvenile idiopathic arthritis,i^jAntinuclear antibodies, ^jDisease-Modifying Antirheumatic Drugs,^klconventional synthetic DMARD, ^lbiological DMARD.

Figure 1. Kaplan-Meier curve shows the time when cases underwent glaucoma surgery after presentation.

Table 2. Variables during observation period.

	Total (n = 185)	Glaucoma surgery (cases, n = 84)	No glaucoma surgery (controls, n = 101)	P-value
IOP^a during first remission (mmHg)^b	19 (16 - 24)	21 (17 - 27)	18 (15 - 22)	0.009
Amount of topical steroids daily during first remission(units)^b	2 (1-3)	3 (2-4)	1 (0-3)	<0.001
Treatment with systemic DMARDS^c during first remission
- Total	101 (55%)	40	61	0.20
- Steroids	46 (25%)	17	29	0.31
- csDMARDs^d	86 (47%)	36	50	0.71
- bDMARDs^e	8 (4%)	2	6	0.29
Time to first uveitis remission (months))^b	5 (3 - 11)	5 (3 - 10)	6 (3 - 13)	0.38
Use of IOP-lowering medication during the observation period	140 (76%)	84	56	<0.001
Time to start IOP-lowering medication (months)^b	6 (1 - 21)	4 (1-18)	8 (1-25)	0.24
Highest IOP during observation period (mmHg)^b	32 (25 - 38)	37 (34 - 42)	27 (20 - 31)	<0.001
Maximum number of IOP-lowering medications^b	3 (1-4)	4 (4 - 5)	1 (0 - 2)	<0.001
Time to highest IOP during observation period (months)^b	18 (6 - 41)	27 (9 - 52)	14 (3 - 36)	0.007
Treatment with systemic DMARD^c during indication for glaucoma surgery
- Total	138 (75%)	64	74	0.73
- Steroids	13 (7%)	2	11	0.002
- csDMARDs^d	132 (71%)	62	70	0.57
- bDMARDs^e	33 (18%)	10	23	0.05
Cataract surgery during observation period^f	64 (35%)	31	33	0.55
Observation period (months)^b,g	44 (24 – 87)	31 (12-54)	64 (37-108)	<0.001

^aIOP = intraocular pressure, ^bmedian (interquartile range), ^cDisease-Modifying Antirheumatic Drugs, ^dconventional synthetic DMARD, ^ebiological DMARD, ^fcataract surgery longer than 3 months before glaucoma surgery, ^gin cases: time to surgery, in controls: total observation period.

Table 3. Interval between the start of a third type of IOP-lowering medication and glaucoma surgery.

Time to surgery	Cumulative number of patients
< 1 year	57 (68%)
< 2 years	64 (76%)
< 3 years	71 (85%)
< 4 years	76 (91%)
< 5 years	78 (93%)
< 6 years	79 (94%)

Table 4. Characteristics of JIA-uveitis.

	Total	Glaucoma surgery (cases, n = 54)	No glaucoma surgery (controls, n = 39)	P-value
Age at uveitis onset (years)^a	5 (3–8)	5 (3–7)	6 (4–11)	0.13^b
Gender – female	61 (66%)	36 (67%)	25 (64%)	0.48^c
Bilateral disease	73 (78%)	42 (78%)	31 (80%)	0.53^c
ANA^dpositive	75 (81%)	46 (85%)	29 (74%)	0.29
Anterior segment complications present at diagnosis^e	55 (59%)	36 (67%)	19 (49%)	0.06^c
Cataract surgery during observation period	38 (41%)	23 (43%)	15 (39%)	0.43^c
IOP^f at diagnosis (mmHg)^a	16 (10–20)	15 (8–21)	16 (10–19)	0.45^b
IOP during first uveitis remission (mmHg)^a	19 (15–23)	21 (18–27)	16 (13–20)	0.001^b
> 2 units of topical steroids daily during uveitis remission	36 (39%)	25 (46%)	11 (28%)	0.054^c
Time to start IOP-lowering medication (months)^a	10 (2–26)	9 (2–24)	13 (1–39)	0.68^b
Time start IOP-lowering medication to surgery (months)^a	n/a	25 (7–39)	n/a	n/a
Time to first uveitis remission (months)^a	6 (3–13)	5 (3–12)	7 (3–15)	0.63^b
Observation period (months)^a,g	51 (26–93)	36 (17–71)	73 (37–110)	0.001^b

^aMedian (interquartile range), ^bMann-Whitney, ^cPearson chi-square, ^dAnti nuclear antibodies, ^eanterior complications at baseline: band keratopathy, cataract, posterior synechiae, ^fIOP = intraocular pressure, ^gin cases: time to surgery, in controls: total observation period