Evaluation of the outcome of long-tube shunt implant surgery in uveitic glaucoma patients by analyzing the background of uveitis.

Abstract

To evaluate the efficacy of long-tube shunt surgery (LTSS) without valve in uveitic glaucoma (UG) eyes. We retrospectively analyzed the data of 45 UG eyes that underwent only LTSS or LTSS combined with trabeculectomy (TLE) (LTSS/TLE). The UG eyes were analyzed by categorizing them into granulomatous/non-granulomatous, steroid responder/non-responder, and primary open-angle glaucoma (POAG) (POAG background)/non-POAG (non-POAG background). All granulomatous UG eyes received a continuous 3-times-daily administration of topical betamethasone post-LTSS. The eyes consisted of granulomatous (37 eyes, 82%)/non-granulomatous (5 eyes, 11%), steroid responder (19 eyes, 42%)/non-steroid responder (13 eyes, 29%), and 20 eyes with POAG or POAG background (p = 0.0022, 83%) among 24 cases of unilateral UG. The 5-year survival rates of only LTSS and LTSS/TLE were 66% and 100%, respectively. Kaplan-Meier survival-curve estimates in the non-granulomatous group were 100% for 6-year postoperative period, while the granulomatous group showed a gradual decrease along the 6-year (81%) postoperative period. The 5-year survival rates in the steroid responder group and the non-steroid responder group eyes were 74% and 78%, respectively. No intraocular pressure (IOP) elevation was observed in the positive steroid responder eyes post-LTSS. LTSS and LTSS/TLE were both effective in UG. Positive steroid response may be masked by LTSS in the positive responder eyes. Continuous administration of topical betamethasone post-LTSS may be important for preventing an IOP spike by suppressing inflammation in the anterior chamber. LTSS combined with TLE may be recommended in eyes with granulomatous UG, and the coexistence of a POAG/POAG background.