Does trabeculectomy influence the course of uveitis?

It was our clinical impression that patients with uveitis who had undergone trabeculectomy had an improvement in their intraocular inflammation following surgery. We undertook a retrospective review of the notes of all patients who underwent unaugmented trabeculectomy for uncontrolled intraocular pressure secondary to uveitis between September 1990-July 1994, at the Uveitis Service of the Birmingham and Midland Eye Centre, UK. The severity of the inflammation and the number of relapses post-trabeculectomy were compared to those during the pre-trabeculectomy period. A total of 32 eyes of 20 patients with various types of uveitis were included in the study. Mean age was 40 years (SD+/-2.5), range: 14-67 years, median follow-up of 53 months (SE+/-1.8), range: 33-84 months. An improvement in the pattern of uveitis post-trabeculectomy, defined as reduction in the severity of the inflammation and the number of relapses, was seen in 23 out of 32 (71.9%) eyes. Furthermore, five out of 15 patients in this group had either their systemic treatment stopped or the number of systemic agents reduced. Another five eyes (15.6%) showed no change in the pattern of uveitis. The remaining four eyes (12.5%) suffered an increase in the number of relapses or increased severity of inflammation requiring additional treatment. It appears that trabeculectomy may have a beneficial effect on the course of uveitis. The mechanism for this is not clear.