Abstract
Purpose: :
Uveitic ocular hypertension and glaucoma are frequently more challenging to manage than nonuveitic glaucoma. Prior studies have demonstrated the relationship between Fluocinolone acetonide (FA) intravitreal implants and glaucoma. The objective of this study is to evaluate the efficacy of intraocular pressure (IOP) lowering surgeries in patients who have undergone a FA implant and compare these results to those previously published in the literature in uveitic patients.
Methods: :
This is a retrospective chart review of seven uveitic patients (11 eyes) who presented to the Wilmer Ocular-Immunology Division over the past 2 years. Patients selected for this study must have undergone FA implantation and had a subsequent glaucoma surgery (either trabeculectomy or glaucoma drainage implant) to control their resultant steroid induced glaucoma. Patients were excluded from this study if they had undergone an incisional glaucoma surgery prior to FA implantation. Glaucoma surgery was considered a success if post-operative IOP was between 6-21 mmHg with or without the use of ocular hypotensive medications.
Results: :
Six eyes underwent trabeculectomy with mitomycin C augmentation and 5 eyes underwent glaucoma drainage implant surgery (two Ahmed devices and 3 Baerveldt devices). The mean follow up was 12 months. In this study, 66.7% of the eyes had an IOP elevation of greater than 30mmHg from their respective baseline IOP’s. The mean time to starting IOP lowering medications following FA implantation was 3 weeks (range 0-5 months). The mean time to glaucoma surgery after undergoing FA implant was 5.9 months (range 0-11 months). Surgical success was 100% at 3, 6, and 9 months for trabeculectomies. Surgical success for tube implants was 80% at 3 months and 100% at 6 and 9 months. There was one case of hypotony with a glaucoma drainage implant at 3 months which resolved at subsequent visits. No cases of hypotony were observed in eyes that underwent trabeculetomies.
Conclusions: :
This case series demonstrates good rates of surgical success for glaucoma filtering surgery in controlling steroid induced ocular hypertension in uveitic patients after FA implantation over a 9 month time period. Trabeculectomies appear as effective as drainage implant surgery in these uveitic patients.
Keywords: inflammation • intraocular pressure