Current Approach in the Diagnosis and Management of Uveitic Glaucoma

Abstract

Uveitic glaucoma (UG) typically is associated with very high intraocular pressure (IOP) and more intense optic nerve damage than other glaucoma types. This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma. It is mandatory to identify the mechanisms of IOP elevation that in many eyes have multiple combined mechanisms. Management of these patients commonly requires an interdisciplinary approach that includes a glaucoma specialist and rheumatologist to control the inflammation and IOP. Glaucoma surgery is required early in these patients due to the high IOP usually present and is less successful than in primary open-angle glaucoma. Recurrent uveitic episodes, multiple mechanism, and the complications associated with uveitis make surgical management of UG challenging. In this review, the management and treatment of UG are updated to clarify the pathogenesis and prevent optic nerve damage.

A Mouse Model of Chronic Ocular Hypertension Induced by Circumlimbal Suture

“…Given suture removal led to IOP reduction within 24 hours, it implies that ocular hypertension is not associated with chronic pathologic responses, such as inflammation of the anterior chamber outflow pathways. [36][37][38] In addition, the data in the rat suture model indicated that the anterior chamber angle is not affected by the suture compression. 8 Furthermore, it is unlikely that we would have affected aqueous formation as it is associated with active transport mechanisms from the blood supply to the anterior eye structures.…”

Surgical outcomes of trabeculectomy and glaucoma drainage implant for uveitic glaucoma and relationship with uveitis activity

“…Our finding in a more racially diverse population also supports these latter two studies. Because of the potential adverse effect of inflammation on surgical outcomes, it is recognized best practice to ensure uveitic activity is well controlled before performing glaucoma surgery . However, often, this is not possible as acute uveitic activity can tip the balance of an already compromised outflow, leading to uncontrolled elevation of IOP not amendable to medical treatment alone.…”

“…Because of the potential adverse effect of inflammation on surgical outcomes, it is recognized best practice to ensure uveitic activity is well controlled before performing glaucoma surgery. 16,17 However, often, this is not possible as acute uveitic activity can tip the balance of an already compromised outflow, leading to uncontrolled elevation of IOP not amendable to medical treatment alone. This was evident in more than one-third of trabeculectomy cases in this study having active uveitis at the time of surgery and had a significantly higher IOP than the GDI group, indicating surgery was performed in a more urgent setting.…”

Clinical results of ab interno trabeculotomy using the trabectome in patients with uveitic glaucoma

“…In these conditions, in addition to elevated IOP from the underlying condition, there is also a very strong component of steroid response. 2 The rates of glaucoma in eyes with inflammation can range from 10%-20%. 3 The elevation of IOP can result from several factors, often in combination.…”