Prevalence of Uveitic Secondary Glaucoma and Success of Nonsurgical Treatment in Adults and Children in a Tertiary Referral Center

Heinz, Carsten; Koch, Jörg; Zurek-Imhoff, Beatrix; Heiligenhaus, Arnd

doi:10.1080/09273940902913035

Cited by 77 publications

(64 citation statements)

References 18 publications

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“…As is often the case in glaucoma-related research, the definition of IOP elevation has varied between studies. In some cases an elevation of more than 5 mmHg after treatment with corticosteroid has been defined as a steroid response [25], and in others an IOP of above 21 mmHg [3] or 24 mmHg [4] has been defined as a steroid response, while others included both [26].…”

Section: Steroid-induced Elevated Iopmentioning

confidence: 99%

“…The need for glaucoma surgery is significantly higher in children, with up to 59% of patients needing various glaucoma procedures compared with 35% of adults [4].…”

Section: Managementmentioning

confidence: 99%

“…A few case series have reported anterior uveitis and conjunctivitis induced by brimonidine tartrate (Alphagan) in patients without any history of uveitis [62,63]. However, in a population of patients with uveitis, the use of IOP-lowering medication has not been shown to induce or exacerbate uveitis [64]. Apraclonidine hydrochloride (Iopidine) is a more favorable agent to use in uveitis, and it has been reported to result in a tremendous drop in IOP of 50.3% in a patient with Posner-Schlossman attack, although the effect is not as dramatic in POAG [65].…”

Section: Medical Management B-blockersmentioning

confidence: 99%

“…The prevalence of intraocular pressure (IOP) elevation in uveitic patients, and those requiring treatment for IOP elevation, was found to be 41.8 and 29.8%, respectively, in a retrospective analysis of 216 patients after a mean followup period of 7.5 years [3]. Another recent study quoted a lower prevalence of 8.6% out of nearly 200 uveitic patients who developed raised IOP or secondary glaucoma after a mean follow-up of 5.7 years [4]. The prevalence of IOP elevation and glaucoma in reported studies depends partly on the definitions used, but also on the case mix reported.…”

mentioning

confidence: 99%

“…The prevalence of IOP elevation and glaucoma in reported studies depends partly on the definitions used, but also on the case mix reported. In the first study [3], IOP elevation was defined as >21 mmHg, compared with >24 mmHg in the second study [4].…”

mentioning

confidence: 99%

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Intraocular pressure elevation in uveitis

Din

Isa

Taylor

et al. 2012

Expert Review of Ophthalmology

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Section: Steroid-induced Elevated Iopmentioning

confidence: 99%

“…The need for glaucoma surgery is significantly higher in children, with up to 59% of patients needing various glaucoma procedures compared with 35% of adults [4].…”

Section: Managementmentioning

confidence: 99%

Section: Medical Management B-blockersmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Intraocular pressure elevation in uveitis

Din

Isa

Taylor

et al. 2012

Expert Review of Ophthalmology

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Evaluation of Retinal Nerve Fiber Layer Thickness in Eyes With Hypertensive Uveitis

et al. 2014

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IMPORTANCE Uveitic glaucoma is among the most common causes of irreversible visual loss in uveitis. However, glaucoma detection can be obscured by inflammatory changes.OBJECTIVE To determine whether retinal nerve fiber layer (RNFL) measurement can be used to detect glaucoma in uveitic eyes with elevated intraocular pressure (IOP). DESIGN, SETTING, AND PARTICIPANTSComparative case series of RNFL measurement using optical coherence tomography performed from May 1, 2010, through October 31, 2012, at a tertiary referral center. We assigned 536 eyes with uveitis (309 patients) in the following groups: normal contralateral eyes with unilateral uveitis (n = 72), normotensive uveitis (Uv-N) (n = 143), raised IOP and normal optic disc and/or visual field (Uv-H) (n = 233), and raised IOP and glaucomatous disc and/or visual field (Uv-G) (n = 88).EXPOSURES Eyes with uveitis and elevated IOP (>21 mm Hg) on at least 2 occasions. MAIN OUTCOMES AND MEASURES Comparison of RNFL values between groups of eyes and correlation with clinical data; risk factors for raised IOP, glaucoma, and RNFL thinning. RESULTS Mean (SD) global RNFL was thicker in Uv-N (106.4 [21.4] μm) compared with control (96.0 [9.0] μm; P < .001) eyes and was thicker in Uv-N eyes with active (119.6 [23.2] μm) compared with quiescent (102.3 [20.8] μm; P = .001) uveitis, which in turn was not significantly different from control eyes (P = .07). Compared with Uv-N eyes, significant RNFL thinning was seen in all quadrants except the temporal in Uv-G eyes and significant thinning in the inferior quadrant of Uv-H eyes with no evidence of disc or visual field changes (P = .03). Risk factors for elevated IOP were male sex and anterior uveitis. Age, higher peak IOP, longer duration of follow-up, and uveitis-induced elevation of IOP were risk factors for glaucoma and RNFL defect.CONCLUSIONS AND RELEVANCE Screening for glaucomatous RNFL changes in uveitis must be performed during quiescent periods. Thinning of the inferior quadrant suggests that glaucomatous damage, more than uveitic ocular hypertension, is in fact occurring. Measurement of RNFL may detect signs of damage before disc or visual field changes and therefore identifies a subgroup that should receive more aggressive treatment.

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Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma

et al. 2015

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IMPORTANCEThe majority of patients with juvenile idiopathic arthritis-related uveitic glaucoma require surgery to control intraocular pressure. Trabeculectomy with mitomycin C (MMC) is a major treatment option, although both chronic inflammation and young age increase risk of filtration failure. Factors that potentially protect from filtration failure are important to identify.OBJECTIVE To evaluate the potential effect of treatment with tumor necrosis factor (TNF) inhibitor on the success of an MMC-augmented trabeculectomy for patients with juvenile idiopathic arthritis-related uveitic glaucoma.

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Prevalence of Uveitic Secondary Glaucoma and Success of Nonsurgical Treatment in Adults and Children in a Tertiary Referral Center

Abstract: Only a limited number of patients with secondary uveitic glaucoma can be sufficiently controlled with topical and systemic antiglaucomatous therapy alone. There is a significantly higher need for glaucoma operations in children.

Cited by 77 publications

References 18 publications

Intraocular pressure elevation in uveitis

Intraocular pressure elevation in uveitis

Evaluation of Retinal Nerve Fiber Layer Thickness in Eyes With Hypertensive Uveitis

Potential Effect of Tumor Necrosis Factor Inhibitors on Trabeculectomy With Mitomycin C for Patients With Juvenile Idiopathic Arthritis–Related Uveitic Glaucoma

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