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Robert John Barry, Savitha Madhusudhan, imran Masood, Peter Shah, Alastair K Denniston; Assessing prevalence and progression of ocular hypertension and glaucoma in a tertiary referral uveitis service. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3706.
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© ARVO (1962-2015); The Authors (2016-present)
Uveitic glaucoma has a multifactorial aetiology, being observed in approximately 20% of patients with uveitis. We assessed the prevalence of ocular hypertension (OHT) and glaucoma in patients attending a tertiary-referral uveitis service, using a novel stratification system to assess disease severity and progression of glaucomatous damage (International Glaucoma Stratification System – IGSS).
Retrospective review of all new referrals to uveitis clinics at University Hospital Birmingham for 3 years between January 2012 and December 2014. Patients diagnosed with OHT or glaucoma at any time during this period were included in analysis if OHT/glaucoma was persistent for at least 3 months, with a minimum 12 months follow-up available. Data extracted included uveitis diagnosis according to the SUN classification and treatment for inflammation and glaucoma. Glaucoma/OHT was graded according to a stratification system defined by clinical parameters including type of diagnosis (primary vs. secondary / OHT vs. glaucoma) and severity according to mean deviation on 24-2 Humphrey Visual Field testing (early <-6dB, moderate -6dB to -12dB, advanced >12dB) at baseline, and 1, 2 and 3 year follow-up.
60/235 (26%) referrals met the inclusion criteria; comprising 92 uveitic eyes. Follow-up data was available for all patients (100%) at 1 year, 49 (82%) at 2 years, and 27 (45%) at 3 years. Progression of glaucoma/OHT was observed in 26/92 (28%) eyes from baseline to year 1, 38/72 (50%) to year 2, and 19/40 (47%) to year 3 despite intensive specialist-led care. Disease stability was achieved in 70% of eyes undergoing glaucoma surgery or laser during the period of observation.
Glaucoma remains a significant cause of co-morbidity in uveitis. There is significant disease progression despite intensive treatment of both inflammation and elevated intra-ocular pressure. Prospective use of the International Glaucoma Stratification System will enable identification of individuals at high risk of visual loss and allow implementation of early targeted interventions to improve visual outcomes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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