Factors of Excessive Proliferation after Trabeculectomy in Pediatric Uveitic Glaucoma

Abstract

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.