Glaucoma associated with uveitis

doi:10.1016/S0039-6257(97)00006-4

Survey of Ophthalmology

Volume 41, Issue 5, March–April 1997, Pages 361-394

https://doi.org/10.1016/S0039-6257(97)00006-4 Get rights and content

Abstract

Raised intraocular pressure is a common and frequently serious complication of anterior uveitis. The milieu of inflammatory cells, the mediators they release, and the corticosteroid therapy used to treat the uveitis can participate in the pathogenesis of uveitic glaucoma. These factors alter the normal anatomic structure of the anterior chamber and angle, influencing aqueous production and outflow. These changes act to disrupt the homeostatic mechanisms of intraocular pressure control. Structural changes in the angle can be acute, such as in secondary angle closure with pupillary block glaucoma, or chronic, such as combined steroid-induced and secondary open angle glaucoma. Management of uveitic glaucoma may be difficult because of the numerous mechanisms involved in its pathogenesis. Diagnostic and therapeutic decisions are guided by careful delineation of the pathophysiology of each individual case. The goal of treatment is to minimize permanent structural alteration of aqueous outflow and to prevent damage to the optic nerve head. This article reviews the pathogenesis of uveitic glaucoma, with specific attention to etiology. Medical and surgical therapies are also discussed, with emphasis on the more recent developments in each category.

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Effect of Early Aqueous Suppression After Valved Tube Shunt Surgery for Uveitic Glaucoma
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To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma.
Retrospective comparative cohort study.
All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine.
Excluding the first postoperative day 1 (POD1), only eyes with IOP 10–15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10–15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP > 21 mmHg, < 5 mmHg, or < 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP > 21 mmHg for 2 consecutive visits in the first 3 months.
Proportion achieving overall success; incidence of hypotony and hypertensive phase.
Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2 ± 10.1 mmHg) and ST (34.6 ± 12.2 mmHg) groups; P = 0.18. Final IOP was lower in the EAS group (12.9 ± 4.6 mmHg) than the ST group (16.4 ± 5.7 mmHg; P = 0.02) on 2.6 ± 0.9 medications in the EAS group and 1.8 ± 1.5 in the ST group (P = 0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (P = 0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4% for EAS, 20% for ST; P = 0.11), hypotony (7% for EAS, 0% for ST; P = 0.50), or hypertensive phase (4% for EAS, 21% for ST; P = 0.09).
EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
The Prevalence of Autoimmune Diseases in Patients with Primary Open-Angle Glaucoma Undergoing Ophthalmic Surgeries
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To assess the prevalence of autoimmune disease (AiD) in patients with primary open-angle glaucoma (POAG) undergoing ophthalmic surgery.
Retrospective, cross-sectional study.
Patients with POAG undergoing any ophthalmic surgery and control subjects undergoing cataract surgery at the Massachusetts Eye and Ear from March 2019 to April 2020.
All available medical records with patient demographics, ocular, and medical conditions were reviewed. Differences in AiD prevalence were assessed and adjusted for covariates using multiple logistic regression. Additionally, a subgroup analysis comparing the POAG patients with and without AiD was performed.
To assess the prevalence of AiD based on the American Autoimmune Related Diseases Association list.
A total of 172 patients with POAG and 179 controls were included. The overall prevalence of AiD was 17.4% in the POAG group and 10.1% in the controls (P = 0.044); 6.4% of POAG patients and 3.4% of controls had more than 1 AiD (P = 0.18). The most prevalent AiDs in POAG group were rheumatoid arthritis (4.6%) and psoriasis (4.1%), which were also the most common in controls (2.8% each). In a fully adjusted multiple logistic regression analysis accounting for steroid use, having an AiD was associated with 2.62-fold increased odds of POAG relative to controls (95% confidence interval, 1.27–5.36, P = 0.009); other risk factors for POAG derived from the analysis included age (odds ratio [OR], 1.04, P = 0.006), diabetes mellitus (OR, 2.31, P = 0.008), and non-White ethnicity (OR, 4.75, P < 0.001). In a case-only analysis involving the eye with worse glaucoma, there was no statistical difference in visual field mean deviation or retinal nerve fiber layer (RNFL) thickness in POAG patients with AiD (n = 30) and without AiD (n = 142, P > 0.13, for both).
A higher prevalence of AiD was found in POAG patients compared with control patients undergoing ophthalmic surgery. The presence of AiD was associated with increased risk for POAG after adjusting for covariates. Additional factors may have prevented a difference in RNFL thickness in POAG patients with and without AiD. Autoimmunity should be explored further in the pathogenesis of POAG.
Hypertensive and HLA-B27 negative uveitis: Disease course and complications
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Analizar los datos clínicos de pacientes con uveítis anteriores agudas hipertensivas HLA-B27 negativas. Se obtuvieron muestras de humor acuoso, en las que se realizó reacción en cadena de la polimerasa (PCR), y se clasificaron los pacientes en 3 grupos según las muestras fueran positivas para citomegalovirus (CMV), virus herpes (VHS-VVZ) o negativas para ambos.
En los 3 grupos de pacientes se recogieron las variables edad, sexo, agudeza visual, presión intraocular (PIO), células en cámara anterior, precipitados retroqueráticos, tratamiento hipotensor, cirugía de glaucoma, retina o trasplante corneal y grosor central de la capa de fibras nerviosas de la retina. Todas las variables fueron recogidas en la visita basal y a los 3, 6 y 12 meses.
Se incluyeron 36 pacientes, con una edad media de 59,78 ± 15,26 años. El valor medio basal de PIO fue 40 ± 10,42 mmHg en el grupo CMV frente a 23,8 ± 10,4 mmHg en el VHS-VVZ y 22,65 ± 9,9 mmHg en el grupo PCR negativo. La frecuencia basal de precipitados retroqueráticos, tratamiento hipotensor, cirugía de glaucoma y trasplante corneal fue mayor en los positivos para CMV. Sin embargo, al año la pérdida de capa de fibras nerviosas de la retina y la tasa de cirugía de glaucoma fue mayor en el grupo PCR negativo. Durante el seguimiento, en los 3 grupos hubo correlación directa y positiva entre la PIO y la inflamación en cámara anterior. Esta correlación fue de 0,94 (p = 0,05) para el positivo para CMV, de 0,24 (p = 0,75) en el de VHS-VVZ y de 0,98 (p = 0,17) en el negativo.
Las uveítis anteriores agudas hipertensivas HLA-B27 negativas con PCR de humor acuoso positiva para CMV tienen una presentación más agresiva inicialmente; sin embargo, al año de seguimiento el daño glaucomatoso es menor que en aquellas con PCR negativa. En las uveítis anteriores agudas hipertensivas, cuando, con el tratamiento oportuno, se controla la inflamación en cámara anterior, se controla la PIO.
To perform a retrospective analysis on patients with HLA-B27 negative hypertensive acute anterior uveitis. Aqueous humor samples were obtained on which a polymerase chain reaction (PCR) test was performed. The patients were then classified into 3 groups depending on whether they were positive for cytomegalovirus (CMV) or herpesvirus (HSV-VZV) or negative for both.
Different variables were collected in successive visits (baseline, 3, 6, and 12 months). The variables were age, sex, visual acuity, intraocular pressure (IOP), cells in the anterior chamber, retro-keratic precipitates, hypotensive treatment, glaucoma or retina surgery, corneal transplantation, and central thickness of the retinal nerve fiber layer.
The sample was 36 patients, with a mean age of 59.78 ± 15.26 years. The mean baseline IOP value was 40 ± 10.42 mmHg in the CMV group compared to 23.8 ± 10.4 mmHg in the HSV-VZV, and 22.65 ± 9.9 mmHg in the negative group. The baseline frequency of retro-keratic precipitates, hypotensive treatment, glaucoma surgery, and corneal transplantation was higher in CMV positives. At one year, the loss of retinal nerve fiber layer and glaucoma surgery was greater in the negative group. In the 3 groups, there was a direct and positive correlation between IOP and inflammation in the anterior chamber. Being 0.94 (P = .05) for the positive for CMV, 0.24 (P = .75) in that of HSV-VZV, and 0.98 (P = .17) in the negative group.
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View all citing articles on Scopus

^☆: Supported in part by a grant from Hôpital Ophtalmique Universitaire Jules Gonin, Lausanne, Switzerland, and NIH grant EY03040, a core grant for vision research.

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Major reviewGlaucoma associated with uveitis☆

Abstract

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

J Cataract Refract Surg

J Cataract Refract Surg

The XXVII Edward Jackson Memorial Lecture. Am J Ophthalmol

Am J Ophthalmol

Exp Eye Res

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

J Cataract Refract Surg

Surv Ophthalmol

Exp Eye Res

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Surv Ophthalmol

Angiotensin converting enzyme system in the normal canine eye: pharmacological and physiological aspects

J Ocul Pharmacol

Metipranolol associated granulomatous uveitis

Br J Ophthalmol

Bilateral simultaneous acute angle closure glaucoma in a herpes zoster patient (letter)

Br J Ophthalmol

Characteristics of corneal endothelial cells in Fuch's heterochromic cyclitis

Acta Ophthalmol

Sympathetic uveitis and phacoanaphylaxis

Am J Ophthalmol

Medical management of glaucoma

Age-related changes in trabecular meshwork cellularity

Invest Ophthalmol Vis Sci

Hétérochromie de Fuchs et fragilité vasculaire

Ophthalmologica

Effect of corticosteroids on intraocular pressure and fluid dynamics. II. The effect of dexamethasone in the glaucomatous eye

Arch Ophthalmol

Mass in the iris and a skin rash in a young man

N Engl J Med

Serum interleukin 2-receptor levels in uveitis

Curr Eye Res

Aqueous protein concentration and cell counts in exfoliation syndrome (abstract)

Invest Ophthalmol Vis Sci

Probability of the presence of glycosaminoglycans in aqueous humor

Graefes Arch Clin Exp Ophthalmol

Cushing-Syndrom und erhöhter Augeninnendruck

Dtsch Med Wochenschr

Topical corticosteroid testing in glaucoma siblings

Arch Ophthalmol

Corticosteroids and intraocular pressure

Arch Ophthalmol

Transscleral ruby laser irradiation of the ciliary body in the treatment of intractable glaucoma

Trans Am Acad Ophthalmol Otolaryngol

Die Lehre v. d. Augenkrankheiten

The effects of prostaglandins on the intraocular pressure of the rabbit

Br J Pharmacol

Vogt-Koyanagi-Harada's disease in Brazil

Jpn J Ophthalmol

Das Glaukom bei der ultrastrukturelle Untersuchungen des Trabekelwerkes

Klin Monatsbl Augenheilkd

Treatment and visual prognosis in Behçet's disease

Br J Ophthalmol

Variations in clinical features of the Vogt-Koyanagi-Harada syndrome

Retina

Major review
Glaucoma associated with uveitis☆