Risk of Ocular Hypertension in Adults with Noninfectious Uveitis

Abstract

Objective To describe the risk and risk factors for ocular hypertension (OHT) in adults with non-infectious uveitis. Design Retrospective, multicenter, cohort study. Participants Patients aged ≥ 18 years with non-infectious uveitis seen between 1979 and 2007 at 5 tertiary uveitis clinics. Methods Demographic, ocular and treatment data were extracted from medical records of uveitis cases. Main outcome measures Prevalent and incident OHT with intraocular pressures (IOP) of ≥21 mmHg, ≥30mmHg and rise of ≥10 mmHg from documented IOP recordings (or use of treatment for OHT). Results Among 5270 uveitic eyes of 3308 patients followed for OHT, the mean annual incidence rates for OHT ≥21mmHg and OHT ≥30mmHg are 14.4% (95%CI: 13.4%, 15.5%) and 5.1% (95% CI: 4.7%, 5.6%) per year, respectively. Statistically significant risk factors for incident OHT ≥30mmHg included: systemic hypertension (adjusted hazard ratio (aHR) = 1.29); worse presenting visual acuity (20/200 or worse vs 20/40 or better, aHR = 1.47); pars plana vitrectomy (aHR = 1.87); prior history of OHT in the other eye: IOP ≥ 21 mmHg (aHR = 2.68), ≥30 mmHg (aHR=4.86), and prior/current use of IOP-lowering drops or surgery in the other eye (aHR = 4.17); anterior chamber cells: 1+ (aHR = 1.43) and ≥2+ (aHR = 1.59) vs none; epiretinal membrane (aHR=1.25); peripheral anterior synechiae (aHR = 1.81); current use of prednisone>7.5 mg/day (aHR = 1.86); periocular corticosteroids in the last three months (aHR = 2.23); current topical corticosteroid use [≥ 8X/day vs. none] (aHR=2.58); and prior use of fluocinolone acetonide implants (aHR = 9.75). Bilateral uveitis (aHR = 0.69) and previous hypotony (aHR=0.43) were associated with statistically significantly lower risk of OHT. Conclusions OHT is sufficiently common in eyes treated for uveitis that surveillance for OHT is essential at all visits for all cases. Patients with one or more of the several risk factors identified are at particularly high risk, and must be carefully managed. Modifiable risk factors, such as use of corticosteroids, suggest opportunities to reduce OHT risk, within the constraints of the overriding need to control the primary ocular inflammatory disease.

Aqueous Humor Dynamics in Uveitic Eyes

“…25 Chronic inflammation of the trabecular meshwork may lead to scar formation and permanent damage to the underlying tissue. 26 In a recent multicenter study of risk factors of ocular hypertension in noninfectious uveitis, 6 the presence of peripheral anterior synechiae (PAS) carried a 3-fold risk of developing OHT, whereas in our study only 17% of uveitic glaucoma/OHT cases had some degree of noncontiguous PAS and none had more than 180 degrees of PAS, suggesting that raised IOP might have been due to microstructural damage to the trabecular meshwork. Additionally, extracellular matrix accumulation in the trabecular meshwork or increased continuity of the endothelial basement membrane along the Schlemm canal, coinciding with long-term use of steroids, may play a part in obstruction of trabecular outflow and, subsequently, raised IOP.…”

“…The prevalence of uveitis varies in different parts of the world [1][2][3] ; however, idiopathic recurrent anterior uveitis 4,5 is the most common diagnosis in those affected. One of the most serious sight-threatening sequelae from this condition is uveitic glaucoma, which has a reported incidence of between 5% and 24% [6][7][8] among long-term uveitic eyes. Despite the relatively high prevalence, there have only been a few previous aqueous humor dynamics studies exploring the pathogenesis of uveitic glaucoma in humans.…”

Quality of Life and Risks Associated with Systemic Anti-inflammatory Therapy versus Fluocinolone Acetonide Intraocular Implant for Intermediate Uveitis, Posterior Uveitis, or Panuveitis

“…2-5 Systemic therapy with corticosteroids is associated with lower risk of ocular complications than local therapy, 1;3;4 but has its own set of potential complications such as corticosteroid-induced diabetes mellitus, hypertension, hyperlipidemia, reduced bone mineral density, weight gain and others. Such complications occur especially when systemic corticosteroids are used at high doses for long periods of time.…”

Sekundärglaukom bei Uveitis

“…Statistisch signifikante Risikofaktoren für eine OHT bei Erwachsenen beinhalten eine systemische Hypertonie, eine schlechte Sehschärfe (≤ 20/200), eine vorangegangene Vitrektomie, eine kontralaterale OHT oder augeninnendrucksenkende Medikation, Vorderkammerzellen ≥ 1+, periphere anteriore Synechien, ≥ 7,5 mg systemische Kortikosteroide pro Tag, okuläre Kortikosteroide in den letzten 3 Monaten und vorherige Verwendung von Fluocinolonacetonid-Implantaten. Eine bilaterale Uveitis und/oder frühere okuläre Hypotonie haben ein statistisch signifikant geringeres OHT-Risiko [12].…”