Outcomes of uveitic glaucoma treatment

Tiffany Ma1, Joanne Sims1, Sonya Bennett1, Shenton Chew1, Rachael Niederer1

Meeting:  2019 RANZCO


Date:      -

Session Title: Glaucoma

Session Time:      -

Purpose: This study aimed to examine the presentation and results of medical and surgical management of a large cohort of uveitic glaucoma patients in the tertiary centre of Auckland, New Zealand.

Methods: A retrospective chart review of all uveitis patients seen between 1 January 2008 and 1 June 2018 was conducted. Subjects were included if they had ocular hypertension (OHT) requiring pressure‐lowering treatment for three months or more, or if they developed uveitic glaucoma.

Data collected included: age, gender, ethnicity, visual acuity and intraocular pressure (IOP) at diagnosis, mechanism of elevated pressure, presence of steroid response, optic nerve damage and visual field defects, treatments received, and any complications or surgical failure.

Results: 188 eyes of 139 subjects were included for analysis. Median age at uveitis diagnosis was 50.5 years and median IOP at diagnosis was 35 mmHg.

Non‐infectious aetiology was more common than infectious, 140 eyes (74.5%) and 48 eyes (25.5%) respectively. The most common diagnoses were idiopathic (27.5%), sarcoidosis (10.9%), herpes zoster (8.7%) and HLA‐B27‐associated (6.6%).

144 eyes (77.0%) developed glaucomatous optic neuropathy.

75 glaucoma surgeries were performed in 68 eyes of 56 subjects (50 trabeculectomies, 18 tubes and 6 minimally invasive glaucoma surgeries). Mean preoperative IOP was 31.3 mmHg. Complete failure occurred in 12 and partial failure in 26 surgeries.

Conclusion: Uveitic glaucoma is aggressive in presentation and may be associated with high IOP. Glaucoma surgery is sometimes unavoidable in these patients. Despite aggressive anti‐inflammatory and IOP‐lowering interventions, vision loss from glaucoma remains a significant poor outcome.