title: Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis-Related Uveitic Glaucoma: A Retrospective Analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Ophthalmology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Sanna
authors.initials: S
authors.lastname: Leinonen
authors.affiliation: Department of Ophthalmology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kaisu
authors.initials: K
authors.lastname: Kotaniemi
authors.affiliation: Department of Ophthalmology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Kivelä
authors.affiliation: Department of Ophthalmology, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Majander
mesh_terms: D000293:Adolescent; D000477:Alkylating Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005902:Glaucoma, Open-Angle / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*; D012189:Retrospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy; D000079424:Tumor Necrosis Factor Inhibitors; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D000477:Alkylating Agents; D000893:Anti-Inflammatory Agents; D018501:Antirheumatic Agents; D000079424:Tumor Necrosis Factor Inhibitors; D016685:Mitomycin