[PDF] Current Approach in the Diagnosis and Management of Uveitic Glaucoma | Semantic Scholar (2024)

The pathophysiology, diagnosis, and management of uveitic glaucoma is discussed to provide a guide for eye‐care providers.

Making a correct diagnosis of uveitis and regular patient follow-up for glaucomatous damage are of crucial importance, and accurate diagnosis allows for prompt implementation of appropriate anti-inflammatory treatment, helping to avoid long-term effects of smoldering inflammation.

Surgical or laser therapy is necessary for refractory glaucoma based on the main factor influencing the success and efficacy of filtration surgery is adequate therapy and control of the intraocular inflammatory process.

A decrease in intraocular pressure (IOP) was found in all surgery interventions, including Glaucoma Drainage Device (GDD) implant, trabeculectomy with 5-Fluorouracil (5FU), and combined trabECUlectomy cataract surgery with or without 5FU, and cyclodestructive laser surgery.

The complexity of uveitic glaucoma is highlighted by analyzing the main pathogenetic mechanisms and the correlations with the inflammatory response, as well as identifying therapeutic targets and the development of new and more efficient therapeutic approaches.

The SITE Research Group reported their experience with OHT in 11,452 eyes of 7062 adults ≥ 18 year of age with noninfectious uveitis and found the annual incidence rates for IOP ≥ 21mmHg and ≥ 30 mmHg to be 14.4% and 5.1%, respectively.

The evidence for various surgical options, or the lack of, in the surgical management of medically refractory glaucoma in uveitis is reviewed.

The risk profile for undergoing glaucoma surgery as outlined in this study is a valuable help to recognize and treat secondary glaucoma in a timely manner.

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There are some situations linked to a high risk of failure of surgery in uveitic glaucoma, which should be avoided when possible, mainly the association of higher risk with combined approaches.

Prostaglandin analogs may be used in uveitic glaucoma when other topical treatments have not lowered IOP to the patient’s target range and there is little evidence that PGA disrupt the blood-aqueous barrier.

The management of uveitic glaucoma requires a careful balance between adequate anti-inflammatory therapy and appropriate intraocular pressure (IOP)-lowering to prevent long-term visual loss.

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, and screening for glaucomatous RNFL changes in uveitis must be performed during quiescent periods.

Patients with uncontrolled uveitic glaucoma who underwent Ahmed valve implant surgery between October 1993 and March 1996 appeared to be a safe alternative in high-risk patients who have had multiple previous ocular surgeries.

The management of angle closure in uveitis should adhere to the principles of managing both uveitic glaucoma and angle closure, which may enable treatment to be targeted at the responsible mechanism.

Adverse reactions, such as increased intraocular pressure and recurrence of inflammation, were noted to occur 7 to 16 days after rechallenging with topical latanoprost therapy for glaucoma in patients with history of uveitic glau coma.

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