Purpose: To describe the clinical course of three pediatric patients with chronic uveitis who developed refractory secondary glaucoma, and discuss treatment challenges.

Methods: Case series of three pediatric patients with refractory uveitic glaucoma, treated and followed at the pediatric ophthalmology unit in Schneider Children’s Medical Center of Israel, by uveitis and glaucoma specialists. Patient- and disease-related data was retrieved and analyzed.

Results:All three patients had chronic non-infectious uveitis, were steroid-dependent and steroids-responders and developed refractory secondary glaucoma. In all patients the intraocular pressure (IOP) became un-controllable shortly following intervention, that even in steroid responders, is usually reversible. Biologic agents were initiated in order to allow a fast discontinuation of steroids. The first patient is a 5-year-old girl, with idiopathic bilateral chronic anterior uveitis, treated with methotrexate and topical steroids. Slight increase in topical treatment caused irreversible uncontrolled IOP despite topical and systemic pressure lowering agents. The second patient is a 12-year-old girl, with JIA-related chronic bilateral anterior uveitis, who was treated with methotrexate, and developed gradual mild IOP elevations that led to dramatic damage to the optic nerve. The third patient is an 11-year-old boy, with bilateral pars planitis, that developed uncontrollable and irreversible increased IOP shorty after subtenon’s injection of medium acting steroids.

Conclusions: Secondary glaucoma is mostly a treatment driven complication. . Abrupt damage may occur despite treatment. Steroid responders should be closely monitored, attempting to avoid this severe clinical course.