0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma A Retrospective Analysis

Sanna Leinonen, MD1; Kaisu Kotaniemi, MD, PhD1; Tero Kivelä, MD, PhD1; Anna Majander, MD, PhD1
[+] Author Affiliations
1Department of Ophthalmology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
JAMA Ophthalmol. 2015;133(11):1323-1328. doi:10.1001/jamaophthalmol.2015.3387.
Text Size: A A A
Published online

Importance  The majority of patients with juvenile idiopathic arthritis–related uveitic glaucoma require surgery to control intraocular pressure. Trabeculectomy with mitomycin C (MMC) is a major treatment option, although both chronic inflammation and young age increase risk of filtration failure. Factors that potentially protect from filtration failure are important to identify.

Objective  To evaluate the potential effect of treatment with tumor necrosis factor (TNF) inhibitor on the success of an MMC-augmented trabeculectomy for patients with juvenile idiopathic arthritis–related uveitic glaucoma.

Design, Setting, and Participants  In a retrospective observational study with a median follow-up of 7.9 years at the Department of Ophthalmology, Helsinki University Hospital, in Helsinki, Finland, 29 eyes of 29 consecutive patients (3.1-20.4 years of age) underwent an MMC-augmented primary trabeculectomy during the period from April 1996 to January 2014. Fifteen patients were treated with systemic TNF inhibitors at the time of their trabeculectomy to control their uveitis, arthritis, or both. No changes were made to the antirheumatic therapy preoperatively.

Main Outcomes and Measures  Successful trabeculectomies, determined by Kaplan-Meier analysis, in which patients have intraocular pressure of 21 mm Hg or lower without antiglaucomatous medications or further glaucoma procedures.

Results  The success rate of trabeculectomy for patients who were treated with TNF inhibitors was 73% (95% CI, 44%-89%) at 1, 5, and 10 years after surgery, whereas the success rates of trabeculectomy for patients who were not treated with TNF inhibitors were 57%, 16%, and 0% at 1, 5, and 10 years after surgery, respectively (P = .01). The trabeculectomies of patients who were treated with TNF inhibitors were successful for a median of 3.2 years (95% CI, 0.3-9.9 years), whereas the trabeculectomies of patients who were not treated with TNF inhibitors were successful for a median of 1.2 years (95% CI, 0.6-3.6 years) (P = .14). Nine eyes of 9 patients had previously undergone cyclodestruction, intraocular surgery, or both (ie, prior ocular surgery). The effect of TNF was observed especially in the eyes of patients who had not undergone prior ocular surgery (at 5 years: 83% success rate for patients who had not undergone prior ocular surgery vs 19% success rate for patients who had). A difference in the overall success rate between patients who had and patients who had not had prior surgery was not identified.

Conclusions and Relevance  Our retrospective data suggest that better control of intraocular pressure was achieved in the eyes of patients with juvenile idiopathic arthritis–related uveitis glaucoma who were treated with TNF inhibitors at the time of their MMC-augmented primary trabeculectomy. The retrospective design of the present study suggests that our data can be used for the planning of future studies but not for making treatment decisions.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure.
Trabeculectomy Survival for Patients Who Did or Did Not Receive TNF Inhibitors

Kaplan-Meier survival analysis of trabeculectomies for 29 eyes of 20 patients with juvenile idiopathic arthritis–related uveitic glaucoma undergoing their first mitomycin C–augmented trabeculectomy. IOP indicates intraocular pressure; TNF, tumor necrosis factor.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

312 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();