Duration 5min, Q&A 3min
Prevalence and Pathomechanisms of Secondary Glaucoma in Granulomatous and Non-Granulomatous Uveitis
To investigate prevalence and pathomechanisms of secondary glaucoma in granulomatous and non-granulomatous uveitis.
Consecutive case notes of 304 patients with uveitis (484 eyes) who visited the National Defense Medical Collage Hospital between April 2010 and March 2013 were reviewed retrospectively.
In the uveitic patients, secondary glaucoma was diagnosed if an IOP of 21 mmHg or higher was recorded in at least two consecutive visits, in the absence of glaucomatous optic neuropathy. Secondary open angle glaucoma (SOAG) was classified into inflammation-induced SOAG and steroid-induced SOAG, and secondary angle closure glaucoma (SACG) was classified into anterior form with peripheral anterior synechiae (PAS) and posterior form with pupillary block (iris bombe) or anterior rotation of the iris-lens diaphragm. Steroid-induced glaucoma was defined as IOP increase to higher than 21 mmHg during steroid administration, and IOP decrease after discontinuation or dose reduction of corticosteroids, with or without medical therapy to control IOP. Anterior form of SACG was defined as a PAS index higher than 75%.
Results and Conclusion
Secondary glaucoma was found in 123 eyes (25.4%) of 93 patients (30.6%), and the patients ranged in age from 14 to 90 years (average 58.2 ± 16.8 years). The follow up period varied from 3 to 94 months, and the mean was 28.0 ± 27.4 months (mean ± SD). Secondary glaucoma in granulomatous uveitis was 80 eyes (65.0%) of 60 patients (64.5%) and that in non-granulomatous uveitis was in 43 eyes (35%) of 33 patients (35.5%). There was statistical difference between them. Among 43 eyes with nongranulomatous uveitis, steroid-induced SOAG was found in 33 eyes (76.7%), inflammation-induced SOAG in 6 eyes (13.9%), and SACG with pupillary block in 4 eyes (9.3%). In contrast, in 80 eyes with granulomatous uveitis, inflammation-induced SOAG was found in 56 eyes (70.0%), steroid-induced SOAG in 19 eyes (23.8%), SACG with PAS in 3 eyes (3.8%), and SACG with anterior rotation of iris-lens diaphragm in 2 eyes (2.5%).
It was demonstrated that prevalence of secondary glaucoma was significantly higher in granulomatous uveitis, than in non-granulomatous uveitis, and the most common cause was inflammation-induced SOAG in granulomatous uveitis while that was steroid-induced SOAG in non-granulomatous uveitis.
[ Keyword ]
secondary glaucoma / uveitis / SOAG / SACG
[ Conflict of Interest ]