For children battling uveitic glaucoma, a condition where glaucoma is associated with inflammation inside the eye, surgery may provide considerable relief. Research suggests that surgical procedures can effectively lower intraocular pressure (IOP) and decrease the need for glaucoma medications. The study also reported positive visual outcomes two years post-surgery.

Pediatric uveitic glaucoma, while uncommon, is a persistent ailment demanding consistent monitoring and long-term care from specialists in both glaucoma and uveitis. Managing inflammation and IOP is crucial to prevent optic nerve damage and amblyopia, also known as lazy eye.

According to Abhiram Manda, BS, an MD student at Vanderbilt University school of Medicine, and his research team, “This study aims to compare the visual outcomes of surgically treated eyes in pediatric patients with inflammatory glaucoma to a cohort of similarly aged pediatric uveitis eyes that did not undergo glaucoma surgery. In doing so, the results of this paper provide readers with the predictive factors associated with good visual outcomes in children with uveitic glaucoma.”

The research team, lead by Manda, gathered information on patients under 18 who were treated at a single academic institution between 2000 and 2020 and had been followed for two years at the vanderbilt Eye institute. The date of surgery was considered “Day 0” for the surgical group, while “Day 0” for the non-surgical group was the date of their initial diagnosis of pediatric uveitis or their first visit to the Vanderbilt Eye Institute.

The final analysis included a total of 36 eyes, equally divided between the surgical and non-surgical groups. The median age in the surgery group was 11.5 years (interquartile range [IQR], 9.25-14), while in the non-surgery group, it was 8.5 years (IQR, 6.0-10). Thirteen eyes in the surgery group had an associated systemic disease at the start of the study, compared to 11 in the non-surgical group.

The study found that 16 surgically treated eyes had anterior uveitis, compared to 12 in the non-surgical group.Among the 18 eyes that underwent surgery, 15 received Baerveldt shunts (10 with 250 mm shunt and 5 with 350 mm shunt), and 3 underwent iridectomies.

Manda and his colleagues reported that the surgically managed eyes had significantly higher IOP at the beginning of the study compared to the non-surgical eyes (median, 31.5 mmHg vs 15 mmHg; P <.001). However, after the follow-up period, there was no significant difference in IOP between the two groups (median 12 mmHg vs 13.5 mmHg, P = .14).

At the beginning of the study, the non-surgical eyes had better visual acuity than the surgical eyes.However, due to the wide range of visual acuity in both groups, the difference was not statistically significant (logMAR 0.35; IQR, 0.1-0.5 vs.1; IQR, 0.03-0.85). After the follow-up period, the visual acuity of the surgical group improved, while that of the non-surgical group remained relatively stable (0.3; IQR, 0.12-0.7]vs 0.1; IQR, 0.03-0.85]).

Notably, 12 of the 18 surgical eyes had cataract surgery before the follow-up, suggesting that cataract growth did not significantly affect visual acuity during the two-year follow-up period. the median number of glaucoma medications used in the surgical eyes decreased substantially from 3.2 +/- 1.6 medications at the start of the study to .67 +/- 1.1 at two years.

Study Limitations and Future Directions

“Judicious use of topical corticosteroids and early initiation of systemic immunosuppression can help maintain uveitis quiescence and prevent further IOP spikes.”

Madna and colleagues acknowledged potential limitations of the study, including the small sample size due to the rarity of pediatric uveitic glaucoma and the fact that all data came from a single tertiary care center.

“Judicious use of topical corticosteroids and early initiation of systemic immunosuppression can help maintain uveitis quiescence and prevent further IOP spikes,” Madna and colleagues wrote. “Ultimately, the next step is to conduct a randomized trial to further guide treatment guidelines in pediatric uveitic glaucoma.”