Inflammatory Disease and Glaucoma

  • Sunita Radhakrishnan
  • Emmett T. CunninghamJr.
  • Andrew G. Iwach
Chapter

Abstract

Elevated intraocular pressure (IOP) is commonly associated with uveitis and may or may not cause optic nerve damage. The mechanism of IOP elevation in uveitis is multifactorial, and for clinical purposes it is helpful to consider the angle status as well as the timing of IOP elevation with respect to the onset of inflammation. Based on these factors, uveitis ocular hypertension or glaucoma may be classified as inflammatory ocular hypertension syndromes (IOHS), acute uveitic angle closure, corticosteroid-induced hypertension/glaucoma, and chronic mixed-mechanism ocular hypertension/glaucoma. Adequate treatment of the underlying inflammatory process is the primary goal in managing this challenging condition. Elevated IOP can be managed with many of the same strategies as primary open angle glaucoma with some key differences – prostaglandin analogs are usually the last choice, laser trabeculoplasty is contraindicated, surgical treatment of any type is associated with a higher risk of hypotony, there is a higher risk of failure of filtering procedures, and ciliodestructive procedures are best avoided due to the risk of phthisis.

Keywords

Corticosteroid Tuberculosis Flare Vasculitis Cataract 

References

  1. 1.
    Moorthy RS, Mermoud A, Baerveldt G, et al. Glaucoma associated with uveitis. Surv Ophthalmol. 1997;41:361–94.PubMedCrossRefGoogle Scholar
  2. 2.
    Reddy S, Cubillan LDP, Havakimyan A, Cunningham ET. Inflammatory ocular hypertension syndrome (IOHS) in patients with syphilitic uveitis. Br J Ophthalmol. 2007;91:1610–2.PubMedCrossRefGoogle Scholar
  3. 3.
    Westfall AC, Lauer AK, Suhler EB, Rosenbaum JT. Toxoplasmosis retinochoroiditis and elevated intraocular pressure. J Glaucoma. 2005;14:3–10.PubMedCrossRefGoogle Scholar
  4. 4.
    Chee SP, Bacsal K, Jap A. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008;145:834–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Jap A, Sivakumar M, Chee SP. Is Posner Schlossman syndrome benign? Ophthalmology. 2001;108:913–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Warwar RE, Bullock JD, Ballal D. Cystoid macular edema and anterior uveitis associated with Latanoprost use: experience and incidence in a retrospective review of 94 patients. Ophthalmology. 1998;105:263–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Wand M, Gilbert CM, Liesegang TJ. Latanoprost and herpes simplex keratitis. Am J Ophthalmol. 1999;127:602–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Nguyen EV, Azar D, Papalkar D. Brimonidine-induced anterior uveitis and conjunctivitis. J Glaucoma. 2008;17:40–2.PubMedCrossRefGoogle Scholar
  9. 9.
    Goyal R, Ram AR. Brimonidine tartrate 0.2 % associated granulomatous anterior uveitis. Eye. 2000;14:908–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Spencer NA, Hall AJ, Stawell RJ. Nd:Yag laser iridotomy in uveitic glaucoma. Clin Experiment Ophthalmol. 2001;29:217–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Lim LL, Smith JR, Rosenbaum JT. Retisert (Bausch & Lomb/control delivery systems). Curr Opin Investig Drugs. 2005;6:1159–67.PubMedGoogle Scholar
  12. 12.
    Stavrou P, Murray PI. Long-term follow-up of trabeculectomy without antimetabolites in patients with uveitis. Am J Ophthalmol. 1999;128:434–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Towler HMA, Bates AK, Broadway DC, et al. Primary trabeculectomy with 5-fluorouracil for glaucoma secondary to uveitis. Ocul Immunol Inflamm. 1995;3:163–70.PubMedCrossRefGoogle Scholar
  14. 14.
    Prata JA, Neves RA, Minckler DS, et al. Trabeculectomy with mitomycin C in glaucoma associated with uveitis. Ophthalmic Surg Lasers. 1994;25:616–20.Google Scholar
  15. 15.
    Noble J, Derzko-Dzulynsky L, Rabinovitch T, Birt C. Outcome of trabeculectomy with intraoperative mitomycin C for uveitic glaucoma. Can J Ophthalmol. 2007;42:89–94.PubMedGoogle Scholar
  16. 16.
    Towler HM, McCluskey P, Shaer B, et al. Long –term follow-up of trabeculectomy with intraoperative 5-fluorouracil for uveitis-related glaucoma. Ophthalmology. 2000;107:1822–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Jampel HD, Jabs DA, Quigley HA. Trabeculectomy with 5-fluorouracil for adult inflammatory glaucoma. Am J Ophthalmol. 1990;109:168–73.PubMedGoogle Scholar
  18. 18.
    Patitsas CJ, Rockwood EJ, Meisler DM, et al. Glaucoma filtering surgery with postoperative 5-Fluorouracil in patients with intraocular inflammatory disease. Ophthalmology. 1992;99:594–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Papadaki TG, Zacharopoulos IP, Pasquale LR, et al. Long-term results of Ahmed glaucoma implantation for uveitic glaucoma. Am J Ophthalmol. 2007;144:62–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Ceballos EM, Parrish 2nd RK, Schiffman JC. Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma. Ophthalmology. 2002;109:2256–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Freedman SF, Rodriguez-Rosa RE, Rojas MC, Enyedi LB. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol. 2002;133:617–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Miserocchi E, Carassa RG, Bettin P, Brancato R. Viscocanalostomy in patients with glaucoma secondary to uveitis: preliminary report. J Cataract Refract Surg. 2004;30:566–70.PubMedCrossRefGoogle Scholar
  23. 23.
    Williams RD, Hoskins HD, Shaffer RN. Trabeculodialysis for inflammatory glaucoma: a review of 25 cases. Ophthalmic Surg. 1992;23:36–7.PubMedGoogle Scholar
  24. 24.
    Kanski JJ, McAllister JA. Trabeculodialysis for inflammatory glaucoma in children and young adults. Ophthalmology. 1985;92:927–30.PubMedCrossRefGoogle Scholar
  25. 25.
    Minckler D, Baerveldt G, Ramirez MA, et al. Clinical results with the Trabectome, a novel surgical device for treatment of open-angle glaucoma. Trans Am Ophthalmol Soc. 2006;104:40–50.PubMedGoogle Scholar
  26. 26.
    Goldstein DA, Godfrey DG, Hall A, et al. Intraocular pressure in patients with uveitis treated with fluocinolone acetonide implants. Arch Ophthalmol. 2007;125:1478–85.PubMedCrossRefGoogle Scholar
  27. 27.
    Zelefsky JR, Cunningham ET Jr. Evaluation and management of elevated intraocular pressure in patients with uveitis. Am Acad Ophthalmol. Focal Points 2010;XXVIII(6), Module 3 of 3.Google Scholar
  28. 28.
    Cunningham ET Jr. Diagnosis and management of acute anterior uveitis. Am Acad Ophthalmol. Focal Points 2002;XX(1) (Section 1 of 3).Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sunita Radhakrishnan
    • 1
  • Emmett T. CunninghamJr.
    • 2
    • 3
    • 4
  • Andrew G. Iwach
    • 5
  1. 1.Glaucoma Center of San Francisco and Glaucoma Research and Education GroupSan MateoUSA
  2. 2.The Uveitis ServiceCalifornia Pacific Medical CenterSan FranciscoUSA
  3. 3.Department of OphthalmologyStanford University School of MedicineStanfordUSA
  4. 4.West Coast Retina Medical Group, Inc.San FranciscoUSA
  5. 5.Glaucoma Center of San FranciscoSan FranciscoUSA

Personalised recommendations