Factors associated with the avoidance of glaucoma surgery in secondary glaucoma due to ocular inflammatory disease

Many cases of hypertensive uveitis progress to visual field narrowing due to difficulty controlling intraocular pressure. The purpose of this retrospective study was to identify factors related to avoidance of trabeculectomy (TLE) in patients with hypertensive uveitis. Participants comprised patients diagnosed with ocular inflammatory disease at Nippon Medical School Tama Nagayama Hospital, Ocular Inflammation Service between April 2018 and September 2022. Logistic regression analysis was performed using avoidance of TLE as the objective variable and the following as explanatory variables: age, sex, use of biologics, granulomatous type, background disease, and treatment. A total of 745 eyes in 480 patients were investigated. Mean age was 57.1 ± 19.6 years, with a male-to-female ratio of 205:275. Hypertensive uveitis was identified in 200 patients (41.7%). The most common causative disease was scleritis (26.5%), followed by sarcoidosis (16.7%), Vogt–Koyanagi–Harada disease (6.0%), Behcet’s disease (5.2%), herpetic keratouveitis (5.0%), HLA-B27-associated uveitis (2.3%), cytomegalovirus iritis/corneal endotheliitis (1.7%), and Posner–Schlossman syndrome (0.6%). The disease type for the remaining 21.9% was unclassifiable. Anti-inflammatory treatments were: topical steroid (100%), sub-conjunctival or sub-Tenon injection of steroid (16.8%), oral steroid (16.6%), oral immunosuppressants (9.1%), and biologics (8.2%). Sixty-eight eyes (9.1%) had a history of TLE. Factors associated with avoidance of TLE were use of biologics (odds ratio [OR] 2.93, p = 0.01) and use of oral immunosuppressants (OR 1.42, p = 0.08). Around 9.1% of hypertensive uveitis cases progress to needing TLE. Use of biologics and oral immunosuppressants may help avoid TLE among patients with hypertensive uveitis.