Pediatric Uveitic Glaucoma Symptoms May be Offset by Surgery, Study Finds

Results from a recent study of uveitic glaucoma in children suggest glaucoma surgery can provide substantial benefits to patients who are refractory to medical management by reducing intraocular pressure (IOP) and glaucoma medication burden. Additionally, patients in the study exhibited excellent visual outcomes at 2 years.1

Although rare, pediatric uveitic glaucoma is a chronic condition that requires constant monitoring and long-term management by both glaucoma and uveitis specialists. Continuous control of inflammation and IOP are also needed to avoid the risk of progressive damage to the optic nerve and the possibility of amblyopia.2

“This study aims to compare the visual outcomes of surgically treated eyes in pediatric patients with inflammatory glaucoma to a cohort of similarly aged pediatric uveitis eyes that did not undergo glaucoma surgery,” wrote Abhiram Manda, BS, an MD student at Vanderbilt University School of Medicine, and colleagues. “In doing so, the results of this paper provide readers with the predictive factors associated with good visual outcomes in children with uveitic glaucoma.”1

Manda and colleagues collected data on patients <18 years of age who received care at a single academic center between 2000 and 2020 and had 2 years of follow-up at the Vanderbilt Eye Institute. The surgical group's baseline, or Day 0, was defined as the date of surgery, while Day 0 for the non-surgical group was defined as the date of their initial diagnosis of pediatric uveitis or their first presentation to the Vanderbilt Eye Institute.1

A total of 36 eyes were included in the final analysis, evenly split between the surgery and non-surgery groups. Median age among the surgery cohort was 11.5 years (interquartile range [IQR],, 9.25-14) and 8.5 years (IQR, 6.0-10) years in the non-surgery cohort. A total of 13 eyes with surgery exhibited an associated systemic disease at baseline, as opposed to 11 among the non-surgical patients.

Investigators noted 16 surgically managed eyes showed anterior uveitis compared to 12 of the non-treated patents; of the 18 who received surgery, 15 received Baerveldt shunts (10 with 250 mm shunt and 5 with 350 mm shunt), and 3 received iridectomies.1

Manda and colleagues indicated that surgically managed eyes exhibited significantly higher IOP at baseline than the non-surgical eyes (median, 31.5 mmHg vs 15 mmHg; P <.001). After follow-up, however, IOP was not significantly different between cohorts (median 12 mmHg vs 13.5 mmHg, P = .14).1

At baseline, non-surgical eyes exhibited better visual acuity compared to surgical eyes, but no statistically significant difference was noted between the two given the wide range of visual acuity in both groups (logMAR 0.35; IQR, 0.1-0.5 vs .1; IQR, 0.03-0.85). After follow-up, the surgical group’s visual acuity increased, while the non-surgical group’s remained relatively stable (0.3; IQR, 0.12-0.7] vs 0.1; IQR, 0.03-0.85]).1

Of note, 12 of 18 surgical eyes underwent cataract surgery before follow-up, which Manda and colleagues note as suggesting that visual acuity was not primarily affected by cataract development during the 2-year follow-up period. Finally, median amount of glaucoma medications in surgical eyes decreased substantially from 3.2 +/- 1.6 medications at baseline to .67 +/- 1.1 at 2 years.1

Madna and colleagues call attention to the study’s potential shortcomings, including its small sample size due to relative infrequency of pediatric uveitic glaucoma and the fact that all included data came from a single tertiary care center.1

“Judicious use of topical corticosteroids and early initiation of systemic immunosuppression can help maintain uveitis quiescence and prevent further IOP spikes,” Madna and colleagues wrote. “Ultimately, the next step is to conduct a randomized trial to further guide treatment guidelines in pediatric uveitic glaucoma.”1

References

1. Manda AR, Ji X, Comstock J, et al. Visual Function and Intraocular Pressure Outcomes Following Surgical Intervention in Pediatric Patients with Inflammatory Glaucoma. Ocul Immunol Inflamm. Published online May 23, 2025. doi:10.1080/09273948.2025.2508408

2. Kalogeropoulos D, Kalogeropoulos C, Moschos MM, Sung V. The Management of Uveitic Glaucoma in Children. Turk J Ophthalmol. 2019;49(5):283-293. doi: