# Childhood Uveitic Glaucoma: Complex Management in a Fragile Population
## 5 Surgical Management
Nevertheless, GDDs have considerable long-term complications, such as corneal swelling and tube erosion through the conjunctiva. Therefore, the choice of filtration surgery should be carefully evaluated according to the clinical situation of the young patient. Pediatric uveitis patients often show an early onset of cataracts due to steroid therapy and prolonged ocular inflammation. Clear vision is pivotal to avoid amblyopia in the pediatric population; therefore, cataract extraction is often necessary for children diagnosed with uveitis to achieve acceptable visual outcomes. Cataract surgery in UG children is challenging for different reasons. First, posterior synechiae, inflammatory membranes on the anterior capsule, small pupils scarcely responsive to mydriatics and capsular bag instability may be intraoperative pitfalls in uveitis eyes. Furthermore, postoperative complications such as macular edema and epiretinal membrane are more likely to occur after phacoemulsification, and any effort should be made to control ocular inflammation before and after cataract surgery in patients with a history of uveitis [83]. Second, the correct timing of cataract surgery in children is still debated. Multiple factors must be considered prior to surgery, such as the patient's age, risk of amblyopia, and the uni- or bilaterality of the cataract. In addition, in childhood Ugs, the timing of phacoemulsification in relation to glaucoma filtering surgery is also critical: if performed separately, phacoemulsification may increase the risk of failure of glaucoma surgery, and glaucoma surgery may accelerate cataract development [84]. Therefore, pediatric patients must be evaluated on a case-by-case basis, using extreme caution, before the final decision is made. Posterior capsulotomy and anterior vitrectomy are recommended in children, and some Authors suggest a complete vitrectomy for young patients with uveitis and cataract associated with JIA [83]. Hydrophobic acrylic Intraocular Lenses (IOLs) are considered the best option for patients affected by uveitis. However, inflammatory membranes and deposits may occur after phacoemulsification with an IOL implant, especially in patients with sarcoidosis and JIA [83]. IOL implant is not recommended in infants younger than 1 year. Choosing the IOL power is not easy in pediatric patients because of continuous ocular growth during childhood. An under-correction of the IOL power, according to the age of the patient, with a proper refractive correction, usually achieves acceptable results [85]. \begin{table}
\begin{tabular}{l l l l} \hline \hline
**Type** & **Model** & **Plate Area (mm2)** & **Plate Material** \\ \hline
**Ahmed® Implant*** & & & \\ Pediatric size & S3 & 96 & polypropylene \\ Pediatric size & FP8 & 96 & silicone \\ Pars plans (Ped) & PC8 & 96 & silicone \\ Pars plana (Ped) & PS3 & 96 & polypropylene \\ \hline
**Moltenos® Implant*** & & & \\ Pediatric & P1 & 80 & polypropylene \\ \hline \hline \end{tabular}  
* valved; ** non valved.  
\end{table} 
Table 4: Main Glaucoma Drainage Devices available for pediatric patients. Surgical aphakia could be an option in patients with uncertain control of inflammation or capsular bag instability. However, IOL implantation is associated with a lower risk of severe hypotony after surgery [86].