Trabeculotomy outcomes in paediatric patients with steroid-induced ocular hypertension or glaucoma: a case series and literature review.

Abstract

The purpose of this study is to assess the 24-month outcomes of trabeculotomy in paediatric patients with steroid-induced ocular hypertension or glaucoma who did not achieve adequate intraocular pressure (IOP) control under maximal medical therapy. A retrospective case series was conducted at Copenhagen University Hospital-Rigshospitalet between February 2018 and January 2022. 13 eyes of eight consecutive paediatric patients (aged 7-17 years) undergoing trabeculotomy for steroid-induced ocular hypertension or glaucoma were included. IOP, the number of pressure-lowering medications (PLMs) used, steroid exposure, visual acuity and postoperative complications were documented over a 24-month follow-up. Complete success was defined as achieving IOP of ≤21 mm Hg without the need for PLMs. Mean preoperative IOP was 29.7 mm Hg despite intensive use of PLMs. Postoperatively, mean IOP decreased significantly, remaining below 16 mm Hg at all postoperative follow-ups with a mean IOP of 15.1 mm Hg at 24 months. All eyes were off PLMs postoperatively, and complete success was achieved in all eyes through 24 months with no postoperative complications. Visual acuity showed slight improvement, though this was not statistically significant. Despite continued corticosteroid use for underlying conditions, no IOP elevation recurred. Trabeculotomy is a safe and effective surgical option for paediatric steroid-induced ocular hypertension or glaucoma, ensuring long-term IOP control without the need for further medication or surgical intervention. This procedure should be considered early in paediatric steroid responders when medical therapy fails to manage IOP adequately, minimising the risk of steroid-induced glaucoma.