Current management of uveitis-associated ocular hypertension and glaucoma

Kesav, Natasha; Palestine, Alan G.; Kahook, Malik Y.; Pantcheva, Mina B.

doi:10.1016/j.survophthal.2019.12.003

Cited by 29 publications

(16 citation statements)

References 80 publications

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“…Uveitic glaucoma is defined as the type of glaucoma that manifests as glaucomatous optic nerve head damage and/or visual field defect due to elevated IOP associated with increased resistance to aqueous outflow following inflammation [ 22 ]. Uveitis was diagnosed based on clinical examination, and its type was classified according to the criteria of the International Uveitis Study group [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma

Lee

Kim

et al. 2022

JCM

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We compared 1-year outcomes of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation with MMC as a first surgical procedure in patients with uveitic glaucoma. A total 38 eyes of 38 patients undergoing trabeculectomy (n =16) or Ahmed valve implantation (n = 22) were included. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg, IOP reduction ≥20% from baseline, no secondary glaucoma surgery, and no loss of light perception. The main outcome measurements including success rate, IOP, and the number of antiglaucoma medications and complications were compared. The overall success rates were comparable between the Ahmed and trabeculectomy groups (81.3 vs. 81.8%, p = 0.987). The mean IOPs were similar as well (p = 0.084), though the number of antiglaucoma medications was significantly lower in the trabeculectomy group than in the Ahmed group (1.0 ± 1.2 vs. 2.2 ± 1.1; p = 0.005). A statistically significant reduction in corneal endothelial cell density was noted in the Ahmed group (p = 0.004). Both treatments offered reasonable IOP control and safety for eyes with uveitic glaucoma. However, significantly fewer antiglaucoma medications were used in the trabeculectomy group. Furthermore, our results suggest that cautious postoperative monitoring with regard to corneal endothelial cell density should be additionally performed after Ahmed valve implantation.

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Section: Methodsmentioning

confidence: 99%

Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma

Lee

Kim

et al. 2022

JCM

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“…The equivalent logarithm of the minimum angle of resolution (logMAR) was calculated and used for analysis [ 15 ]. Complications included posterior synechiae, cataract, band keratopathy, uveitic ocular hypertension (uveitic OHT, defined as intraocular pressure > 21 mmHg without optic disk or visual field changes), steroid-induced ocular hypertension (SIOHT, defined as IOP increase > 5 mmHg due to glucocorticoid use in the eye) [ 16 ], uveitic glaucoma (UG, defined as repeated IOP measurements > 21 mmHg with optic disk changes and/or visual field changes), and cystoid macular edema (CME). Ocular surgery was classified according to the indication.…”

Section: Methodsmentioning

confidence: 99%

Demographic and clinical features of pediatric uveitis and scleritis at a tertiary referral center in China

et al. 2022

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Background To analyse demographic, clinical features, treatment and therapeutic outcomes of pediatric uveitis and scleritis patients. Subjects The clinical records of pediatric uveitis and scleritis cases between January 2012 and December 2020 at a tertiary uveitis service center in Tianjin Medical University Eye Hospital (TMUEH) were reviewed. Results In total, 209 patients (337 eyes) were included, 49.3% were male. The median onset age was 9.0 (IQR, 7.0–12.0) years. Chronic uveitis and scleritis accounted for 86.1%. Panuveitis (29.2%), anterior uveitis(29.2%), and intermediate uveitis (22.0%) were the most common presentations. The most common diagnoses were idiopathic (71.3%), JIA (8.1%), and infectious uveitis (4.8%). At baseline, 40.7% patients received oral corticosteroid therapy; during follow-up, corticosteroids (66.0%), disease-modifying antirheumatic drugs (61.2%), and biologic agents (35.4%) were the mainstay. Posterior synechia (26.1%) and cataracts (25.5%) were the most common complications. In acute cases, the median best corrected visual acuity (BCVA) was 0.99 (IQR, 0.5–1.0) at baseline and 0 (IQR, 0–0) at last follow-up; in chronic cases, the median BCVA improved from 1.09 (IQR, 0.5–2.0) to 0.27 (IQR, 0–0.5), with anterior chamber cell grade significantly declining. Ten eyes underwent cataract surgery during regular follow-up and achieved satisfactory long-term visual outcomes and decreased burden of immunosuppressants. The incidence of steroid-induced ocular hypertension was 41.0%, and children with frequent instillation of eyedrops were at high risk. Conclusions Most cases were of chronic uveitis and scleritis requiring long-term systemic immunosuppressive therapies in pediatric uveitis and scleritis in China. Good management of complications is important for long-term prognosis.

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“…These deficits could be abrogated by a week of systemic immunosuppressant therapy with fingolimod, a sphingosine-1phosphate receptor agonist, a drug that is used in relapsingremitting multiple sclerosis disease, thus offering another therapeutic approach to combat optic nerve damage due to pigment accumulation in the ANC of the eye that prevents AQH drainage and results in OHT. Mycophenolate, sustained release corticosteroids (Borkar et al, 2017), other pharmacological agents, trabeculectomy and AQH drainage shunts (Kwon et al, 2017), along with new generation biologics (Thomas et al, 2019) provide much hope for patients who succumb to non-infectious posterior uveitis, and uveitis-associated OHT/glaucoma (Kesav et al, 2020).…”

Section: Various Forms Of Glaucomamentioning

confidence: 99%

Therapeutic Drugs and Devices for Tackling Ocular Hypertension and Glaucoma, and Need for Neuroprotection and Cytoprotective Therapies

Sharif

2021

Front. Pharmacol.

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Damage to the optic nerve and the death of associated retinal ganglion cells (RGCs) by elevated intraocular pressure (IOP), also known as glaucoma, is responsible for visual impairment and blindness in millions of people worldwide. The ocular hypertension (OHT) and the deleterious mechanical forces it exerts at the back of the eye, at the level of the optic nerve head/optic disc and lamina cribosa, is the only modifiable risk factor associated with glaucoma that can be treated. The elevated IOP occurs due to the inability of accumulated aqueous humor (AQH) to egress from the anterior chamber of the eye due to occlusion of the major outflow pathway, the trabecular meshwork (TM) and Schlemm’s canal (SC). Several different classes of pharmaceutical agents, surgical techniques and implantable devices have been developed to lower and control IOP. First-line drugs to promote AQH outflow via the uveoscleral outflow pathway include FP-receptor prostaglandin (PG) agonists (e.g., latanoprost, travoprost and tafluprost) and a novel non-PG EP2-receptor agonist (omidenepag isopropyl, Eybelis®). TM/SC outflow enhancing drugs are also effective ocular hypotensive agents (e.g., rho kinase inhibitors like ripasudil and netarsudil; and latanoprostene bunod, a conjugate of a nitric oxide donor and latanoprost). One of the most effective anterior chamber AQH microshunt devices is the Preserflo® microshunt which can lower IOP down to 10–13 mmHg. Other IOP-lowering drugs and devices on the horizon will be also discussed. Additionally, since elevated IOP is only one of many risk factors for development of glaucomatous optic neuropathy, a treatise of the role of inflammatory neurodegeneration of the optic nerve and retinal ganglion cells and appropriate neuroprotective strategies to mitigate this disease will also be reviewed and discussed.

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Current management of uveitis-associated ocular hypertension and glaucoma

Cited by 29 publications

References 80 publications

Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma

Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma

Demographic and clinical features of pediatric uveitis and scleritis at a tertiary referral center in China

Therapeutic Drugs and Devices for Tackling Ocular Hypertension and Glaucoma, and Need for Neuroprotection and Cytoprotective Therapies

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