Giant-cell arteritis with bilateral uveitic glaucoma

Bilateral uveitic glaucoma occurred in a patient with giant-cell arteritis. The mechanism appeared to be immunologic, not ischemic.     

Management of uveitic glaucoma with Ahmed glaucoma valve implantation

OBJECTIVE: To evaluate the safety and efficacy of Ahmed glaucoma valve implantation for the management of glaucoma associated with chronic uveitis. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Nineteen patients (21 eyes) with chronic uveitis underwent Ahmed glaucoma valve implantation for uncontrolled glaucoma between 1995 and 1998. INTERVENTION: All patients had their uveitis controlled before surgery via immunomodulatory therapy. Ahmed glaucoma valve implantation was performed. Immunosuppression was continued in the early postoperative period for strict control of inflammation. MAIN OUTCOME MEASURES: Control of intraocular pressure (IOP). A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired IOP. Visual acuity and complications associated with the surgery were monitored. RESULTS: The postoperative follow-up averaged 24.5 months. At the most recent visit, all 21 eyes had IOPs between 5 and 18 mmHg. The average pressure reduction after Ahmed glaucoma valve implantation was 23.7 mmHg. The average number of antiglaucoma medicines required to achieve the desired IOP was reduced from 3.5 before surgery to 0.6 after surgery. No eye lost even a single line of Snellen acuity at the most recent postoperative visit. Two eyes developed hypotony in the course of follow-up. One resolved without specific intervention, and the other eye required two autologous blood injections and tube ligature to correct the hypotony. One eye underwent Ahmed glaucoma valve replacement for abrupt valve failure. Two eyes underwent penetrating keratoplasty for reasons believed to be unrelated to the glaucoma surgery. Kaplan-Meier life-table analysis showed a cumulative probability of success after Ahmed glaucoma valve implantation of 94% at 1 year. CONCLUSIONS: Ahmed glaucoma valve implantation can be an effective and safe method in the management of uveitic glaucoma. The authors hypothesize that control of the patients' uveitis, through preoperative and long-term postoperative immunomodulatory therapy, may have contributed to the success rate reported herein.     

Animal model for uveitic glaucoma

Background: This study was carried out in order to improve the understanding of the pathogenesis of uveitic glaucoma Methods: Uveitis was induced in 48 Lewis rats by S-antigen injection. Intraocular pressure (10P) was measured by Tono-Pen-2 daily for 24 days in 16 animals. Histopathology was performed sequentially in 14 rats on days 3, 5, 7, 9, 12, 15 and 18 after S-antigen injection. Aqueous dynamics studies were performed on days 0, 3, 7, 14 and 21. Aqueous humor production was measured using an FIT-Calbumin dilution technique; outflow facility was measured using anterior chamber infusion with constant pressure Results: IOP decreased to a mean of 16.5 +-4.3 mmHg from days 2-5 after S-antigen injections from a mean pre-experimental value of 20.5 +-5.4 mmHg. IOP increased from days 6 to 20 (35.8+-9.1 mmHg; P=0.00001). Histopathologic study revealed inflammation of the anterior and posterior segments from days 9 to 21 after S-antigen injection. Aqueous humor production decreased and outflow facility increased at day 3 after S-antigen injection. At days 7 and 14 after S-antigen injection, acqueous humor production was increased while outflow facility remained normal or was decreased Conclusion: This model of uveitis glaucoma is characterized by three overlapping phases: (1) ocular hypertension, (2) ocular hypertension associated with clinical and histologic inflammation and (3) anatomic sequelae of uveitis and variable IOP. This model permits in vivo studies of mechanisms of IOP change associated with uveiteis.     

小梁切除术联合自体巩膜植入术治疗青光眼的临床研究

目的观察小梁切除术联合自体巩膜植入术治疗青光眼的临床疗效。方法对12例(12眼)青光眼患者施行小梁切除术联合自体巩膜植入术。术后观察眼压、视力、滤过泡形态、并发症等,并做超声生物显微镜(UBM)观察。结果经3～18mo的随访,术后视力11眼(92%)维持不变或提高。眼压由术前平均(36.15±11.39)mmHg降至术后1a平均(13.21±4.98)mmHg,有非常显著性差异(P<0.01),末次随访眼压≤21mmHg者11眼(92%),其中9眼形成弥散性滤过泡,术后前房轻度变浅4眼,术后3～7dUBM检查睫状体脱离2眼,无其它并发症发生。结论小梁切除术联合自体巩膜植入术,能有效降低眼压,经济安全术后视力稳定,值得临床应用推广。     

Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients

Background: The poor long-term success rate of repeat trabeculectomies in refractory uveitic glaucoma (UG) patients has led to the use of glaucoma drainage devices (GDDs). However, the success and complication rates of GDDs in UG patients utilizing a control group with standard demographic data, design, and surgical technique have never been evaluated. Methods: Fifteen patients (15 eyes) with chronic uveitis and 53 patients (53 eyes) with uncontrolled open-angle glaucoma (OAG) who underwent Ahmed glaucoma valve (AGV) implantation were included in a retrospective, comparative, case-controlled study. Postoperative intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and complications were compared. Results: There was a significant difference between the UG versus the OAG group with respect to age only (59.3 years vs 68.4 years, p = 0.006). Regression analysis of the postoperative IOP controlled for age and glaucoma type, and preoperative IOP revealed significantly lower IOP in the UG group at 1 month (p = 0.04; 95% confidence interval [CI] -5.9 to 0.15) and 2 months (p = 0.008; 95% CI -6.0 to 0.97). No significant differences were found at 3, 6, 12, 24, and 30 months. The cumulative success rates at 3 to 30 months for the UG and OAG groups were 80% to 66.6% versus 84.9% to 57% (p = 0.713), respectively. The only complication between the 2 groups that was significantly different was tube removal, which occurred more often in the UG group (p = 0.018). Interpretation: AGV implantation is an effective and safe procedure in the management of UG, similar to primary OAG.     

Trabeculectomy in Nigerian patients with open-angle glaucoma.

Filtering procedures for glaucoma in Africans are considered to be failures owing to their propensity for increased fibrosis. However, favourable results from trabeculectomy in African patients with glaucoma are reported. Most of these are from such modifications of technique as non-suturing of flaps, sclerectomy, posterior lip cautery, or administration of high doses of steroids. In this study 95.4% success with a virtual absence of complications is reported from a standard technique of trabeculectomy and no steroids.     

Efficacy and safety of latanoprost in eyes with uveitic glaucoma

Background  To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. Methods  Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. Results  Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 ± 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 ±0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 ± 8.4 mmHg to 18.6 ± 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 ±8.1 mmHg to 22.6 ±10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. Conclusion  Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma. The authors have no proprietary interest in any aspect of this study.     

Trabeculectomy for advanced glaucoma

The objective of this study is to evaluate the visual prognosis and postoperative course in advanced glaucoma patients who underwent trabeculectomy. The records of 30 patients with advanced visual field (VF) defects undergoing trabeculectomy were retrospectively reviewed. Severe VF defects were defined as those with a sensitivity of ≤5 dB either in more than 85% of test points, excluding the central four points, or in >75% of test points, including three of the central four points with threshold automated perimetry. Main outcome measures were intraocular pressure (IOP), corrected visual acuity (VA) and mean deviation (MD) of VF tests. Mean preoperative IOP, VA and MD values were compared with their respective postoperative values. The latest examination of each patient was used to determine postoperative outcome measures. In addition, any complications encountered were recorded. A total of 34 trabeculectomies were performed. The mean age was 59.3 years (13–80 years). The mean follow-up time was 41.1 months (3–120 months). Preoperatively the mean IOP was 28.4 ± 13.1 mmHg, and the mean postoperative IOP was 14.8 ± 5.0 mmHg (P = 0.001). Preoperatively the mean VA was 0.87 ± 80, and the mean value of the MD was −24.5 ± 6.7 dB. At the latest follow-up there was no significant difference in VA (0.89 ± 79, P = 0.699) and MD (−23.9 ± 6.7, P = 0.244) values. Transient hypotony occured in five eyes while one eye with mitomycin C trabeculectomy experienced extended hypotony. Ten eyes showed reduction of VA between 1 and 5 lines due to cataracts and five eyes had late bleb failure with uncontrolled IOP. One patient had late endophthalmitis and one patient presented with blebitis, both of which were successfully treated. No patients experienced wipe-out phenomenon. In conclusion, our study of advanced glaucoma patients undergoing trabeculectomy, vision was preserved with no cases of unexplained loss of central vision. IOP was largely controllable, with cataract being the leading factor decreasing VA at late term.     

小梁切除术联合丝裂霉素C治疗难治性青光眼

目的 :探讨小梁切除术联合丝裂霉素C治疗难治性青光眼的效果。方法 :采用小梁切除术联合术中应用丝裂霉素C ,对 3 4例 (4 7眼 )难治性青光眼进行了手术治疗 ;术后进行了 1年的随访。结果 :术后前房均形成良好。术后 1年随访 ,Ⅰ型滤过泡 2 7眼 ,Ⅱ型 19眼 ,Ⅲ型 1眼。术后 1周、 1个月、 6个月、 1年的平均眼压值分别为 10 2 3± 6 41、 12 43± 7 62、 16 0 3± 6 19、 18 5 5± 5 95mmHg。视力增进 2 8眼 ,无变化 19眼。结论 :小梁切除术联合丝裂霉素C是治疗难治性青光眼的有效方法。     

持续性高眼压青光眼小梁切除术的临床观察

目的观察持续性高眼压青光眼小梁切除术疗效。方法对30例(30眼)持续性高眼压青光眼患者采用透明角膜穿刺术,缓慢降低眼压,然后采用小梁切除术,完成手术。术后随访3～14mo。结果术后平均眼压为17.07mmHg,比术前平均眼压降低34.37mmHg,手术成功率为90%。全部病例无严重并发症。结论透明角膜穿刺术联合小梁切除术降低眼压的术式,可有效地控制眼压,减少并发症,提高一次手术成功率。     

巩膜层间隧道房水引流术治疗难治性青光眼

目的探讨巩膜层间隧道房水引流术治疗难治性青光眼的临床效果。设计前瞻性随机对照临床研究。研究对象 87例(98眼)难治性青光眼患者。方法将不同类型难治性青光眼患者随机分为2组,隧道组(50眼)行巩膜层间隧道房水引流术,在浅层巩膜下纵形切除5．0mm×1.5mm条状饭层巩膜和常规的小梁切除,条状巩膜远端超过巩膜床1．5-2．0mm,对照组(48 眼)行常规的小梁切除术。术后随访6-12个月。主要指标视力、眼压、滤过泡、术巾及术后并发症。结果 (1)术后视力隧道组和对照组比较差异无统计学意义(x2=1．15,P=0．76)。(2)术后1周两组眼压与术前相比差异有统计学意义,而组间比较差异无统计学意义(t=1.85,P=0．08);术后6个月隧道组平均眼压(14．34±3．95)mmHg.对照组(19．57±7．76)mmHg;手术成功率:隧道组 88．00％,对照组64．58％,差异均有统计学意义(P<0．05)。(3)隧道组功能性滤过泡82,0％,对照组60．4％,两组比较差异有统计学意义(x2=5．59,P=0．02)。(4)术后隧道组出现浅前房较对照组多,治疗后1周内恢复正常,没有其他并发症。结论对于难治性青光眼,与常规小梁切除术比较,巩膜层间隧道房水引流术在防止滤过道瘢痕形成,术后眼压控制等方面均有明显优势。     

Trabeculectomy with mitomycin C for post-keratoplasty glaucoma

AIM: To investigate the effect of trabeculectomy with and without mitomycin C in post-keratoplasty glaucoma. METHODS: A retrospective study was performed on patients who underwent trabeculectomy for glaucoma after penetrating keratoplasty. 34 eyes of 32 patients were included in this study. 26 eyes received trabeculectomy with mitomycin C and eight eyes without mitomycin C. The procedure was deemed successful if the intraocular pressure was maintained below 21 mm Hg with or without use of additional antiglaucoma medication (mean follow up time 22.3 (SD 10.3) months). RESULTS: At the last examination trabeculectomy was successful in 19 of 26 eyes (73.0%) with mitomycin C (+) and two of eight (25.0%) without (p=0.0219). When the prognosis was analysed by Kaplan-Meier curve, the mitomycin C (+) group showed a better prognosis (p=0.0182). Mean intraocular pressure and average number of glaucoma medications improved in the group with mitomycin C without severe side effects on the graft. Graft rejection after trabeculectomy was seen in two eyes in the mitomycin C group. Final graft clarity rate was 69.2% (18/26) in the mitomycin C (+) group and 37.5% (3/8) in the mitomycin C (-) group. Complications such as persistent epithelial defect, cystoid macular oedema, choroidal detachment, leakage from bleb were seen in four eyes in the mitomycin C (+) group and in one eye in the mitomycin C (-) group. CONCLUSIONS: Trabeculectomy with mitomycin C showed better results for glaucoma following keratoplasty.     

Trabeculectomy and nonpenetrating surgery in glaucoma

The purpose of the study is to compare the efficiency of classical trabeculectomy and with the punch and nonpenetrating deep-sclerectomy in patients with primary open angle glaucoma. The studied groups comprise patients with uncontrolled intra-ocular pressure with medical therapy and/or laser. The results of the study emphasize the following conclusions: the decrease of intra-ocular pressure is comparable in classical trabeculectomy and with punch the decrease of intra-ocular pressure is comparable in classical trabeculectomy and nonpenetrating surgery. we consider the non penetrating surgery an interesting alternative to the classical trabeculectomy, with better control of intra-ocular pressure the complications of non penetrating surgery are reduced.     

小梁切除术联合明胶海绵植入治疗青光眼的临床研究

目的观察小梁切除术联合明胶海绵植入治疗青光眼的临床疗效。方法对24例(24只眼)青光眼患者施行小梁切除术联合明胶海绵植入。术后观察眼压、视力、滤过泡形态、并发症等,并做超声生物显微镜(UBM)观察。结果经6～18个月的随访,22只眼术后视力(91.7%)维持不变或提高。眼压由术前平均(41.15±10.24)mmHg降至末次随访平均(14.12±4.89)mmHg,有非常显著性差异(P<0.01),末次随访眼压≤21 mmHg者22只眼(91.7%),均为功能性滤过泡,术后前房变浅4只眼,术后3～7 dUBM检查睫状体脱离2只眼。结论小梁切除术联合明胶海绵植入能有效降低眼压,经济安全,术后视力稳定,值得临床应用推广。     

Overcoming diagnostic and treatment challenges in uveitic glaucoma

Uveitic glaucoma is a range of disorders that results in optic nerve damage from elevated intraocular pressure secondary to intraocular inflammation. As compared to primary open angle glaucoma, uveitic glaucoma is associated with a more aggressive disease course caused by very high intraocular pressure levels that wax and wane. Diagnosis is often based on clinical presentation, disease course, and associated systemic manifestations. Diagnostic imaging plays an important role in both diagnosis and management. While the mechanisms of uveitic glaucoma vary, treatment requires strict control of the inflammation and may involve additional intraocular pressure lowering techniques. Management often dictates an interdisciplinary approach as systemic association and treatment is common. When topical management does not slow the progression of optic nerve damage and vision loss, surgical intervention is required. A significant portion of patients with uveitic glaucoma will eventually require surgical intervention and the appropriate referrals should be made. By nature, success rates of surgical intervention in uveitic glaucoma patients are lower than non‐inflammatory causes of elevated intraocular pressure and glaucomatous damage. Chronic inflammation, multiple mechanisms, systemic associations, and unpredictable response to treatment make uveitic glaucoma challenging to manage. This review will discuss the pathophysiology, diagnosis, and management of uveitic glaucoma to provide a guide for eye‐care providers.