7 common mistakes in managing uveitic glaucoma

7 common mistakes in managing uveitic glaucoma

Behçet’s disease is a complex multi-system disorder of unknown aetiology characteristically presenting with recurrent oral ulcers. Treatment should be tailored to the individual patient. For example, retinitis refers to an inflammation of the retina and iritis to an inflammation of the iris. 8 – Jha P, Bora PS, Bora NS. Trauma is usually classified as blunt or penetrating – both types can lead to secondary glaucoma. Uveitis is caused by disorders of diverse etiologies including wide spectrum of infectious and non-infectious causes. Preoperative factors include proper patient selection and counseling and preoperative control of inflammation.

A Medline search was conducted for relevant articles published in English. PGA have near absence of systemic side effects, although do have other commonly encountered ocular adverse effects. Although there can be cells, corneal edema and elevated IOP are the predominant findings and the fellow eye will show the narrow angle. Surgical management is challenging because of the increased risk of post-operative inflammation and failure to control intraocular pressure (IOP) [3]. Metipranolol, including the unpreserved preparation, should be avoided because of its association with anterior granulomatous uveitis [3, 26, 27]. Patients with uveitic glaucoma often need more than one drug to manage the IOP. In 2009, an aqueous tap done for persistently high IOP (42 mmHg) showed positive for CMV antigen by a multiplex PCR and negative for herpes simplex virus (HSV), varicella zoster virus (VZV), rubella, chikungunya, toxoplasma and Mycobacterium tuberculosis (MTb).

“About 30% to 40% of herpetic eyes have IOHS, and the dictum is, IOHS is herpetic until proven otherwise,” Dr. Considering treatment, laser trabeculoplasty is not effective and I would prefer trabeculectomy with adjunctive mitomycin-C. Subsequently, it was suggested that this “Chandler syndrome” and the “progressive essential iris atrophy” are two different forms of the same disease [6, 7]. Infliximab therapy at 5 mg/kg was administered at 0, 2, and 6 weeks, and every 8 weeks thereafter. Other infections associated with IOHS include toxoplasmosis and syphilis. Ocular hypertension can also occur with sarcoidosis, which has not been linked definitively to infection, but suspicion for an infective cause remains, and with Posner-Schlossman syndrome, which is widely thought to be form fruste herpetic anterior uveitis. A diagnostic workup including complete blood count, liver and kidney function tests, human leukocyte antigen-B27 typing, syphilis serology, chest X-ray, tuberculin skin test and serum angiotensin converting enzyme assay was performed on each patient.

7 common mistakes in managing uveitic glaucoma
Cunningham said the finding of cells in the anterior chamber with elevated IOP is not that uncommon in eyes with Fuchs Uveitis Syndrome (formerly called Fuchs Heterochromic Iridocyclitis), but the IOP tends to increase over time secondary to progressive angle damage rather than acutely. HLA-B27 typing was performed in patients with anterior or panuveitis (n=34). Glaucomatocyclitic crisis: First described by Posner and Schlossman in 1948, presents in the 20 – 60 years age group, typically with unilateral recurrent episodes of mild cyclitis and heterochromia. In this situation, treatment of the anterior chamber inflammation alone does not resolve elevated IOP because the anti-inflammatory treatment has not addressed the angle closure. She eventually required a filtering surgery. Dr. Cunningham noted that treatment for pupillary seclusion varies by country.

All patients were followed at Tohoku University for at least 1 year. In cases such as this one of phacoantigenic uveitis, it is best to quiet the eye as much as possible before cataract extraction. Figure 2: Visual field testing showed a repeatable early superior arcuate defect O.D. In Liberia, the Partnership for Research on Ebola Virus in Liberia (PREVAIL) – jointly run by the National Institutes of Health (NIH) and Liberia’s Ministry of Health – provides a\u00a0comprehensive eye clinic in Monrovia. She also developed low-grade pain in her left eye that was thought to be the result of bleb dysesthesia and hypotony. Rather, the corticosteroid should be maintained while adding medication to control IOP. Treatment with corticosteroids should be continued until the inflammation is controlled, as defined by ≤ 1+ cells.

Surgical intervention is more challenging in the presence of chronic inflammatory changes like synechiae or pupillary membranes. “Don’t taper the corticosteroid until the inflammation is controlled, and in the meantime, deal with the elevated IOP by any means necessary,” he stated. Almost half the patients had been previously diagnosed with anterior uveitis (48.6%), Posner–Schlossman syndrome (36.7%) or secondary glaucoma/ocular hypertension (39.4%). Antiglaucoma therapy should be carried out at elevated intraocular pressure. Evaluation and management of elevated IOP in patients with uveitis. Dr. 2004;138(1):46-54.

Although prostaglandin analogues have been said to cause inflammation, prostaglandin analogue-induced uveitis appears to be uncommon. Avoid oral carbonic anhydrase inhibitors, especially acetazolamide (eg, Diamox), in patients with sickle cell trait or disease. Mr. Dr. Cunningham highlighted two exceptions—herpetic uveitis, because there are reports associating use of a prostaglandin analogue with viral reactivation; and chronic unilateral uveitis, where a prostaglandin analogue can induce periorbitopathy with fat atrophy that can result in cosmetically unacceptable oculofacial asymmetry. The mainstays of surgical management for medically uncontrolled uveitic glaucoma include trabeculectomy and tube shunt surgery. Cunningham noted that it can be easy to overlook the need to monitor eyes with uveitis and ocular hypertension for angle damage and to check for visual field loss because these cases tend to be so complex and because the primary focus is on controlling the inflammation.

For that reason, and because he expects a need for more aggressive intervention to control IOP, Dr. However, there is still a possibility that vitreous can occlude the pupil and cause acute angle closure, or that if the lens capsule has been breached, leached proteins can cause an inflammatory response leading to a secondary uveitic glaucoma (phacoanaphylactic glaucoma).

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