Viscocanalostomy in patients with glaucoma secondary to uveitis: Preliminary report

Abstract

Purpose: To assess the efficacy of viscocanalostomy in eyes with uncontrolled glaucoma secondary to uveitis. Setting: Immunology and Uveitis Service, Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milan, Italy. Methods: All consecutive patients with glaucoma secondary to uveitis and inadequate intraocular pressure (IOP) control (IOP >21 mm Hg) under maximum-tolerated medical therapy had viscocanalostomy. Patients with active uveitis at the time of surgery, peripheral anterior synechias in the upper quadrant, previous ocular surgery, or sight in only 1 eye were excluded. Eleven eyes of 11 patients with a mean age of 52.2 years ± 19.9 (SD) were operated on. The etiology of the uveitis was recorded. The ocular variables were IOP, best corrected visual acuity, number of antiglaucoma medications, and complications. Success was defined as an IOP between 6 mm Hg and 21 mm Hg (inclusive) without medication (complete success), or with 1 or more antiglaucoma medications and/or goniopuncture (qualified success). The mean follow-up was 45.9 ± 11.6 months (range 23 to 56 months). Results: Viscocanalostomy significantly reduced IOP from a mean baseline value of 35.1 ± 7.0 mm Hg (range 23 to 48 mm Hg) to a mean final value of 18.1 ± 4.9 mm Hg (range 12 to 30 mm Hg) ( P<.0001). Complete success was achieved in 6 eyes (54.5%) and qualified success, in 10 eyes (90.9%). The mean number of preoperative and final antiglaucoma medications was 3.4 ± 0.8 (range 2 to 4) and 0.7 ± 1.2 (range 0 to 3), respectively ( P = .0004). Complications were minor and included transient hyphema and postoperative IOP spike. Conclusion: This preliminary study suggests that viscocanalostomy is a safe, effective surgical alternative for treating glaucoma in patients with uveitis.