Secondary Glaucoma in Patients with Uveitis

Abstract

Purpose: To evaluate the prevalence of secondary glaucoma (SG), clinical forms of uveitis more frequently associated with glaucoma, and describe the treatment and complications encountered in a cohort of patients with glaucoma and uveitis during a 10-year period. Methods: The hospital records of patients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary for a decade were reviewed for cases of SG. Results: One hundred and twenty of the 1,254 patients (9.6%) with uveitis developed SG. SG was more frequent in anterior uveitis (67%) but was also associated with posterior uveitis (13%) and pars planitis (4%). Herpetic keratouveitis (22%), Fuchs’ iridocyclitis (19%), juvenile rheumatoid arthritis-associated iridocyclitis (16%), syphilis (14%), and sarcoidosis (12%) were the leading types of uveitis associated with SG. Despite aggressive medical and surgical therapy, SG was associated with progressive visual field loss and optic nerve damage in 39 patients (33%). Conclusion: SG is an underappreciated, vision-threatening complication in patients with uveitis. Increased vigilance for emergence of this complicating problem during the care of patients with uveitis is warranted, and medical and surgical treatment for reducing IOP should be especially aggressive in these patients. We hypothesize that earlier, more aggressive treatment of uveitis will reduce the presence of glaucoma as an additional vision-robbing complication of uveitis.

Corticosteroid-induced glaucoma: a review of the literature

“…A significant minority (10%) of patients with uveitis show a rise in IOP. 73 Although IOP often falls in an acutely inflamed eye (due to a reduction in aqueous production and a four-fold increase in uveo-scleral outflow), 74 a rise occurs if this effect is exceeded by obstruction of the TM outflow pathway. 75 An increase in outflow resistance can be due, in part, to the increase in aqueous protein content, accumulation of cellular debris in the TM, angle closure through anterior synechiae formation and, in addition, an iatrogenic corticosteroid response.…”

Uveitis and Glaucoma: A Critical Review

“…12 Another study reported chronic and recurrent course of uveitis as to be predominantly associated with secondary glaucoma. 14 In the author's data of 200 patients, the course of disease in anterior uveitis revealed significant difference between glaucomatous and nonglaucomatous uveitic populations (p < 0.05). Patients with recurrent uveitis had an odds ratio of 4.90 and patients with chronic uveitis had an odds ratio of 3.61 when compared with patients with acute uveitis in favor of developing secondary glaucoma.…”

“…From a total population of 1,254 cases of uveitis, SG was found in 153 eyes of 120 patients (12% of eyes; 10% of patients) and OHT was detected in additional 86 patients (7%). 14 In a retrospective study of 374 cases, Saouli et al determined prevalence of OHT to be 12% (45 cases) with evidence of glaucomatous optic neuropathy seen in three patients only. 15 Takahashi et al reported SG in 293 eyes (18.3%) of 217 patients (19.6%) in a retrospective study of 1,099 patients (1,604 eyes) from Japan.…”

“…16 Merayo-Lloves et al also reported open angles in majority of eyes in their study (80%). 14 Gonioscopic findings have been evaluated by only few studies in literature. Authors found angle to be open in 70.0 and 47.6%; partly closed (PAS less than 180°) in 18.0 and 26.2%; and closed (PAS greater than 180°) in 12.0 and 26.2% patients with uveitis and uveitic glaucoma respectively.…”

“…14,16,17,7 A study of relative frequency of SG per disease showed that herpes virus-associated uveitis was most likely to cause SG (23%) followed by Fuchs' heterochromic iridocyclitis (19%), Vogt-Koyanagi-Harada (18%), JRA (16%), syphilis (14%) and sarcoidosis (12%) though most of SG cases were secondary to idiopathic uveitis, sarcoid and JIA-associated uveitis. Herpes virus-associated iridocyclitis was the leading cause of anterior uveitis associated with SG, while sarcoidosis accounted for the majority of posterior intermediate and panuveitis cases.…”