Uveitic glaucoma in children: a systematic review on surgical outcomes

Author: van Meerwijk CLLI, Jansonius NM, Los LI.

Geographical coverage: Not reported

Sector: Biomedical

Sub–sector: Treatment

Equity focus: Not reported

Study population: Children with uveitic glaucoma

Review type: Effectiveness review

Quantitative synthesis method: Narrative synthesis

Qualitative synthesis method: Not applicable

Background 

Paediatric uveitis is often diagnosed late and may lead to secondary glaucoma in about 26 % of cases. Between 30 % and 61 % of affected children require surgery – including angle surgery, fistulising procedures and glaucoma drainage implants (GDIs) – to control intra‑ocular pressure (IOP). Surgery is challenging because of the young age of patients and the underlying inflammation.

Objectives 

To compare outcomes and complications of surgical interventions for secondary glaucoma in paediatric uveitis.

Main findings 

Surgery lowers uncontrolled IOP and can prevent vision loss, but long‑term success varies between techniques.

Fourteen observational studies (no randomised controlled trials) examining six surgical techniques were included. All procedures reduced IOP and the need for IOP‑lowering medication, but success rates declined over time. Angle surgery achieved success in 76–90 % of eyes at one year, falling to 48–81 % at five years or longer. Fistulising surgery success fell from 55–73 % at one year to 16–73 % at five years or longer, though outcomes improved slightly when tumour necrosis factor‑α inhibitors were used. GDIs recorded 56–95 % success at two years and 38–89 % at five years or longer. Cyclophotocoagulation showed the poorest results (0 % complete and 32 % qualified success at one year) and required frequent re‑operations.

Hypotony was the most common complication, particularly after fistulising surgery (8–71 %). Other adverse events included hyphaema, cataract progression and re‑operations for ocular hypertension.

Methodology 

PubMed and Embase were searched in January 2022 for studies reporting surgical outcomes in children with uveitic glaucoma. Eligible studies included at least 10 eyes per intervention, mean follow‑up of at least one year and data on IOP, medication use or complications. One researcher performed the search. Evidence was graded with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, and findings were synthesised narratively.

Applicability / external validity 

Evidence quality is low owing to retrospective designs, small sample sizes and heterogeneity in outcome definitions, limiting the ability to recommend one surgical approach over another.

Geographic focus 

Authors did not report the geographic location of included studies.

Summary of quality assessment

The authors did not specify language restrictions, the number of reviewers involved or provide a list of excluded studies, and study authors were not contacted for additional data.