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Goniotomy for Non-Infectious Uveitic Glaucoma in Children

Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in t...

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Autores principales: van Meerwijk, Charlotte L. L. I., Edema, Astrid B., van Rijn, Laurentius J., Los, Leonoor I., Jansonius, Nomdo M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057863/
https://www.ncbi.nlm.nih.gov/pubmed/36983202
http://dx.doi.org/10.3390/jcm12062200
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author van Meerwijk, Charlotte L. L. I.
Edema, Astrid B.
van Rijn, Laurentius J.
Los, Leonoor I.
Jansonius, Nomdo M.
author_facet van Meerwijk, Charlotte L. L. I.
Edema, Astrid B.
van Rijn, Laurentius J.
Los, Leonoor I.
Jansonius, Nomdo M.
author_sort van Meerwijk, Charlotte L. L. I.
collection PubMed
description Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with pediatric uveitis receive biologics as immunosuppressive therapy for a prolonged period, with potential implications for the outcome. The purpose of the study is to evaluate the efficacy and safety of a goniotomy procedure in pediatric non-infectious uveitis in a retrospective, multicenter case series. The primary outcomes were the postoperative intraocular pressure (IOP), number of IOP-lowering medications, and success rate. Postoperative success was defined as 6 ≤ IOP ≤ 21 mmHg, without major complications or re-interventions. Fifteen eyes of ten children were included. Median age of the included patients at goniotomy was 7 years; median follow-up was 59 months. Median (interquartile range) IOP before surgery was 30 (26–34) mmHg with 4 (3–4) IOP-lowering medications. At 1, 2, and 5 years after goniotomy, median IOP was 15, 14, and 15 mmHg with 2 (0–2), 1 (0–2), and 0 (0–2) medications, respectively (p < 0.001 postoperatively versus preoperatively for all timepoints). Success rate was 100%, 93%, and 80% after 1, 2, and 5 years, respectively. There were no significant changes in visual acuity and uveitis activity or its treatment, and there were no major complications. Our results show that the goniotomy is an effective and safe surgery for children with uveitic glaucoma.
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spelling pubmed-100578632023-03-30 Goniotomy for Non-Infectious Uveitic Glaucoma in Children van Meerwijk, Charlotte L. L. I. Edema, Astrid B. van Rijn, Laurentius J. Los, Leonoor I. Jansonius, Nomdo M. J Clin Med Article Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with pediatric uveitis receive biologics as immunosuppressive therapy for a prolonged period, with potential implications for the outcome. The purpose of the study is to evaluate the efficacy and safety of a goniotomy procedure in pediatric non-infectious uveitis in a retrospective, multicenter case series. The primary outcomes were the postoperative intraocular pressure (IOP), number of IOP-lowering medications, and success rate. Postoperative success was defined as 6 ≤ IOP ≤ 21 mmHg, without major complications or re-interventions. Fifteen eyes of ten children were included. Median age of the included patients at goniotomy was 7 years; median follow-up was 59 months. Median (interquartile range) IOP before surgery was 30 (26–34) mmHg with 4 (3–4) IOP-lowering medications. At 1, 2, and 5 years after goniotomy, median IOP was 15, 14, and 15 mmHg with 2 (0–2), 1 (0–2), and 0 (0–2) medications, respectively (p < 0.001 postoperatively versus preoperatively for all timepoints). Success rate was 100%, 93%, and 80% after 1, 2, and 5 years, respectively. There were no significant changes in visual acuity and uveitis activity or its treatment, and there were no major complications. Our results show that the goniotomy is an effective and safe surgery for children with uveitic glaucoma. MDPI 2023-03-12 /pmc/articles/PMC10057863/ /pubmed/36983202 http://dx.doi.org/10.3390/jcm12062200 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
van Meerwijk, Charlotte L. L. I.
Edema, Astrid B.
van Rijn, Laurentius J.
Los, Leonoor I.
Jansonius, Nomdo M.
Goniotomy for Non-Infectious Uveitic Glaucoma in Children
title Goniotomy for Non-Infectious Uveitic Glaucoma in Children
title_full Goniotomy for Non-Infectious Uveitic Glaucoma in Children
title_fullStr Goniotomy for Non-Infectious Uveitic Glaucoma in Children
title_full_unstemmed Goniotomy for Non-Infectious Uveitic Glaucoma in Children
title_short Goniotomy for Non-Infectious Uveitic Glaucoma in Children
title_sort goniotomy for non-infectious uveitic glaucoma in children
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10057863/
https://www.ncbi.nlm.nih.gov/pubmed/36983202
http://dx.doi.org/10.3390/jcm12062200
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