Factors of Excessive Proliferation after Trabeculectomy in Pediatric Uveitic Glaucoma

Objective: to study efficacy and factors of excessive proliferation after trabeculectomy (T) in pediatric uveitic glaucoma (UG).

Patients and Methods. 102 children aged from 3 to 17.5 years (mean 124.5 ± 2.8 month) with uncontrolled on maximum topical hypotensive therapy open angle or combined (with peripheral anterior synechiae) form of UG underwent T (148 eyes, 180 operations). 76.1 % operations were performed with intraoperative 5-fluorouracil, 8.3 % — with mitomycin C, 6.1 % — with bioresorbable, 1.7 % — with collagen drainage, 7.8 % — without antimetabolites or drainages. Kaplan-Meier survival analysis was performed.

Results. Overall absolute (without hypotensive therapy) success probabilities were 67 %, 46 %, 39 %, qualified success (with hypotensive therapy) — 93 %, 72 %, 54 % at 1, 3, 5 years after T respectively. Factors associated with failure were primary location of inflammation in anterior uvea, aphakic or pseudophakic eye, repeat T, bioresorbable drainage (vs. 5-fluorouracil), persistent inflammation after T. Age and uveitis activity at the moment of T, duration hypotensive therapy before primary T, postoperative complications (9.4 %), frequency of postoperative topical steroid had no significant influence on surgical success.

Conclusion. T with intraoperative antimetabolites is effective, safe and nowadays may be recommended as first choice operation in pediatric open angle or combined UG. 

1. Katargina L.A., Khvatova A.V. Endogenous uveitis in children and adolescents. Moscow: Meditsina; 2000. 320 p. (In Russ.).

2. Ceballos E.M., Beck A.D., Lynn M.J. Trabeculectomy with antiproliferative agents in uveitic glaucoma. J Glaucoma. 2002;11(3):189–196. DOI: 10.1097/00061198200206000-00005

3. Chawla A., Mercieca K., Fenerty C., Jones N.P. Outcomes and complications of trabeculectomy enhanced with 5-fluorouracil in adults with glaucoma secondary to uveitis. J Glaucoma. 2013;22(8):663–666. DOI: 10.1097/IJG.0b013e318255dc07

4. Kaburaki T., Koshino T., Kawashima H., Numaga J., Tomidokoro A., Shirato S., Araie M. Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis. Eye (Lond). 2009;23(7):1509–1517. DOI: 10.1038/eye.2009.117-cme

5. Komae K., Takamoto M., Tanaka R., Aihara M., Ohtomo K., Okinaga K., Matsuda J., Nakahara H., Fujino Y., Kaburaki T. Initial trabeculectomy with mitomycin-c for secondary glaucoma-associated with uveitis in Behçet disease patients. J Glaucoma. 2017;26(7):603–607. DOI: 10.1097/IJG.0000000000000665

6. Towler H.M., McCluskey P., Shaer B., Lightman S. Long-term follow-up of trabeculectomy with intraoperative 5-fluorouracil for uveitis-related glaucoma. Ophthalmology. 2000;107(10):1822–1828. DOI: 10.1016/s0161-6420(00)00351-1

7. Katargina L.A., Khvatova A.V., Denisova E.V. The effectiveness of trabeculectomy with the use of cytostatics in treatment of postuveal glaucoma in children. Fyodorov Journal of Ophthalmic Surgery = Oftal’mokhirurgiya 2002;3:37–40 (In Russ.).

8. Siddique S.S., Suelves A.M., Baheti U., Foster C.S. Glaucoma and uveitis. Surv Ophthalmol. 2013;58(1):1–10. DOI: 10.1016/j.survophthal.2012.04.006

9. Freedman S.F., Rodriguez-Rosa R.E., Rojas M.C., Enyedi L.B. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol. 2002;133(5):617– 621. DOI: 10.1016/s0002-9394(02)01344-2

10. Ho C.L., Wong E.Y., Walton D.S. Goniosurgery for glaucoma complicating chronic childhood uveitis. Arch Ophthalmol. 2004;122(6):838–844. DOI: 10.1001/archopht.122.6.838

11. Wang Q., Wang J., Fortin E., Hamel P. Trabeculotomy in the treatment of pediatric uveitic glaucoma. J Glaucoma. 2016;25(9):744–749. DOI: 10.1097/ IJG.0000000000000516

12. Kanski J.J., McAllister J.A. Trabeculodialysis for inflammatory glaucoma in children and young adults. Ophthalmology. 1985;92(7):927–930. DOI: 10.1016/s01616420(85)33933-7

13. Williams R.D., Hoskins H.D., Shaffer R.N. Trabeculodialysis for inflammatory glaucoma: a review of 25 cases. Ophthalmic Surg. 1992;23(1):36–37.

14. AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol. 2002;134(4):481–498. DOI: 10.1016/s0002-9394(02)01658-6

15. Almobarak F.A., Alharbi A.H., Morales J., Aljadaan I. The influence of phacoemulsification on intraocular pressure control and trabeculectomy survival in uveitic glaucoma. J Glaucoma. 2017;26(5):444–449. DOI: 10.1097/IJG.0000000000000646

16. Broadway D.C., Chang L.P. Trabeculectomy, risk factors for failure and the preoperative state of the conjunctiva. J Glaucoma. 2001;10(3):237–249. DOI: 10.1097/00061198-200106000-00017

17. Ehrnrooth P., Lehto I., Puska P., Laatikainen L. Phacoemulsification in trabeculectomized eyes. Acta Ophthalmol Scand. 2005;83(5):561–566. DOI: 10.1111/j.16000420.2005.00499.x

18. Fontana H., Nouri-Mahdavi K., Lumba J., Ralli M., Caprioli J. Trabeculectomy with mitomycin C: outcomes and risk factors for failure in phakic open-angle glaucoma. Ophthalmology. 2006;113(6):930–936. DOI: 10.1016/j.ophtha.2006.01.062

19. Gressel M.G., Heuer D.K., Parrish R.K. 2nd. Trabeculectomy in young patients. Ophthalmology. 1984;91(10):1242–1246. DOI: 10.1016/s0161-6420(84)34179-3

20. Heuer D.K., Gressel M.G., Parrish R.K. 2nd, Anderson D.R., Hodapp E., Palmberg P.F. Trabeculectomy in aphakic eyes. Ophthalmology. 1984;91(9):1045–1051. DOI: 10.1016/s0161-6420(84)34196-3

21. Iwao K., Inatani M., Seto T., Takihara Y., Ogata-Iwao M., Okinami S., Tanihara H.J. Long-term outcomes and prognostic factors for trabeculectomy with mitomycin C in eyes with uveitic glaucoma: a retrospective cohort study. Glaucoma. 2014;23(2):88–94. DOI: 10.1097/IJG.0b013e3182685167

22. Jacobi P.C., Dietlein T.S., Krieglstein G.K. Primary trabeculectomy in young adults: long-term clinical results and factors influencing the outcome. Ophthalmic Surg Lasers. 1999;30(8):637–646.

23. Kwon H.J., Kong Y.X.G., Tao L.W., Lim L.L., Martin K.R., Green C., Ruddle J., Crowston J.G. Surgical outcomes of trabeculectomy and glaucoma drainage implant for uveitic glaucoma and relationship with uveitis activity. Clin Exp Ophthalmol. 2017;45(5):472–480. DOI: 10.1111/ceo.12916

24. Law S.K., Shih K., Tran D.H., Coleman A.L., Caprioli J. Long-term outcomes of repeat vs initial trabeculectomy in open-angle glaucoma. Am J Ophthalmol. 2009;148(5):685–695.e1. DOI: 10.1016/j.ajo.2009.05.032

25. Patel H.Y., Danesh-Meyer H.V. Incidence and management of cataract after glaucoma surgery. Curr Opin Ophthalmol. 2013;24(1):15–20. DOI: 10.1097/ICU.0b013e32835ab55f

26. Shimizu A., Maruyama K., Yokoyama Y., Tsuda S., Ryu M., Nakazawa T. Characteristics of uveitic glaucoma and evaluation of its surgical treatment. Clin Ophthalmol. 2014;8:2383–2389. DOI: 10.2147/OPTH.S72383

27. Katargina L.A., Arestova N.N., Denisova E.V., Ibeyd B.N.A. YAG-laser refistulization of the internal fistula after trabulectomy in children with postuveal glaucoma. Fyodorov Journal of Ophthalmic Surgery = Oftal’mokhirurgiya 2019;1:57–61 (In Russ.). DOI: https://doi.org/10.25276/0235-4160-2019-1-57-61

28. Katargina L.A., Denisova E.V., Ibeyd B.N.A. The role of ultrasound biomicroscopy in the diagnosis and selection of treatment tactics in children with postuvel glaucoma. Russian Pediatric Ophthalmology = Rossiiskaya pediatricheskaya oftal’mologiya. 2017;12(4):187–192 (In Russ.). DOI: 10.18821/1993-1859-2017-12-4-187-192