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

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Abstract

Purpose

To evaluate the efficacy of long-tube shunt surgery (LTSS) without valve in uveitic glaucoma (UG) eyes.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

The authors wish to thank John Bush for editing the manuscript.

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Juntendo Urayasu Hospital, Urayasu, Japan

    Satoshi Watanabe & Nobuyuki Ebihara

  2. Department of Ophthalmology, Japanese Red Cross Medical Center, 4-1-22 Hiroo Shibuya-ku, Tokyo, Japan

    Teruhiko Hamanaka & Kanae Kobayashi

  3. Suwa University of Science, Chino, Japan

    Tetsuro Sakurai

  4. Ishida Eye Clinic, Joetsu, Japan

    Nobuo Ishida

Authors
  1. Satoshi Watanabe
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  2. Teruhiko Hamanaka
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  3. Tetsuro Sakurai
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  4. Kanae Kobayashi
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  5. Nobuo Ishida
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  6. Nobuyuki Ebihara
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Contributions

TH was involved in study concept and design, data acquisition, management, and interpretation, drafting of the manuscript, and review of the published literature. SW contributed to data acquisition and interpretation, drafting of the manuscript, and review of the published literature. KK provided data acquisition. NI gave data acquisition and management, and manuscript final version approval. TS analyzed the data. NE was involved in manuscript final version approval.

Corresponding author

Correspondence to Teruhiko Hamanaka.

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All authors declare that there is no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board (IRB) of the Japanese Red Cross Medical Center, Tokyo, Japan.

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Watanabe, S., Hamanaka, T., Sakurai, T. et al. Evaluation of the outcome of long-tube shunt implant surgery in uveitic glaucoma patients by analyzing the background of uveitis. Int Ophthalmol 41, 509–517 (2021). https://doi.org/10.1007/s10792-020-01601-3

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  • DOI: https://doi.org/10.1007/s10792-020-01601-3

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