The efficacy of composite drainage implantation in childhood uveitic glaucoma

PURPOSE: To evaluate the efficacy of trabeculectomy with Glautex drainage implantation in children with uveitic glaucoma (UG).

METHODS: We analyzed the results of trabeculectomy with Glautex drainage implantation in 11 children with UG aged 4-15 years, including 4 children who already previously underwent glaucoma surgery.

RESULTS: Qualified success rate 3, 12 and 24 months after the surgery (with and without hypotensive medications) amounted to 72.7, 54.5 and 45.4% respectively, absolute success — to 36.4, 27.3 and 27.3%. IOP decompensation in all cases was caused by excessive wound healing in the filtering bleb area. All patients with long-term glaucoma compensation Glautex drainage implantation was the first glaucoma surgery they underwent, and the efficiency of repeated operations was lower than that of primary ones. There were no significant differences in the efficacy of operations in phakic eyes and in cases of artiphakia or aphakia. The results also showed no clear dependence on systemic immunosuppressive therapy or lack thereof, and on uveitis etiology (rheumatoid, idiopathic). Postoperative adverse effects included 1 case of drainage eruption through the conjunctiva 3.5 weeks after the operation with conjunctival healing after the removal of the exposed drainage fragment followed by topical medical treatment, and 1 case of flat ciliochoroidal detachment, which reversed after medical treatment.

CONCLUSION: Trabeculectomy with Glautex drainage implantation, especially if performed as a repeated hypotensive surgical intervention, is not effective enough in children with UG due to extremely intense excessive scarring in extrascleral and scleral areas of the surgical site. Further research is needed to find effective methods of surgical treatment and excessive proliferation prevention in children with UG.

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