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Yael Sharon, Ronit Friling, moshe lusky, Belén Quizhpe Campoverde, Amer Radgonde, Michal Kramer; Uveitic Glaucoma: Long-term Clinical Outcome and Risk Factors for Progression. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4125.
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To study the long-term clinical outcome of patients with uveitic glaucoma and to identify possible risk factors for disease progression.
Retrospective case series of patients diagnosed with uveitic glaucoma who attended uveitis and glaucoma clinics at two tertiary university-affiliated medical centers in 2003-2015. Patient- and disease-related data was retrieved from the medical files as follows: demographics, type of uveitis, type and time of glaucoma onset, topical and systemic therapy, and ocular surgeries. Clinical outcome parameters and visual fields measured at baseline, 6 and 12 months, and 2, 3, 5, and 10 years were recorded. Main outcome measure was achievement of treatment goals of maintaining intraocular pressure (IOP) at <21 mmHg and preserving visual field and optic nerve.
The study group included 34 patients (53 eyes), 20 adults and 14 children. The most common type of uveitis was idiopathic chronic anterior uveitis (83% of eyes); the most common type of glaucoma was chronic open-angle glaucoma (79% of eyes). Mean follow-up time was 7 years. Sixty-two percent of eyes were steroid responders. Seventy-three percent of eyes required long-term therapy to control IOP. Sixty nine percent of eyes had a normal IOP at ≥2 years' follow-up. There was a significant association of higher IOP and greater number of IOP-lowering medications with posterior synechiae, peripheral anterior synechiae, treatment with topical and systemic steroids, and longer duration of immunomodulatory therapy (P<0.05). Glaucomatous visual field defects developed in 49% of eyes; trabeculectomy was required in 32%. Mean cup-to-disc ratio was significantly higher at the last follow up (P<0.05), but the visual field loss did not progress in most patients.
Chronic severe uveitis, expressed by the presence of structural complications and the need for immunomodulatory therapy, is associated with high IOP and with the need for more IOP lowering medications. However, uveitis severity is unrelated to glaucomatous damage. In the majority of our patients, treatment successfully maintains a balanced state between control of the inflammatory process and prevention of glaucomatous optic neuropathy.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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