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Abstract #15968 Published in IGR 2-3
Uveitis and glaucoma.
Caprioli J; Samson CM; Foster CS; Araie M; Rockwood EJJournal of Glaucoma 2000; 9: 463-7
In this series "Cases in Controversy" the section editor Joseph Caprioli discusses the subject of uveitis and glaucoma with several experts. Michael Samson, Stephen Foster, Makoto Araie and Edward Rockwood. The case presented is a 53 years old black woman with glaucoma and uveitis. There are no known medical problems. She has Cosopt and brimonidine 2 dd in each eye. Furhtermore she has 1% Prednisolone acetate and 1% cyclopentolate in both eyes several times a day. She complains of poor vision and glare and dislikes systemic corticosteroid therapy because of weight gain. Visual acuity is 20/70 in each eye. She has the usual signs of uveitis and intraocular pressure is 19 mmHg in her right and left eye. Both angles are open. There are posterior synechiae. The optic discs and perimetry are normal. The experts comment on causes, treatment and cataract extraction in these cases.Samson and Foster start by stressing a thorough medical history. They describe their examination of patients in detail. For treatment in this case where sarcoidosis has been discovered they follow the stepladder approach. Steroids are the first line of treatment. Second step is systemic steroids. However this is often disappointing. The next step would be a treatment with Methotrexate. Cataract extraction by phacoemulisification with intra-ocular lens implantation is well tolerated in most patients with anterior uveitis. The authors discuss exceptions to this statement. They would not try surgery until the uveitis had been controlled by at least three months. Araie discusses the differential diagnosis of anterior uveitis. As treatment options he has corticosteroids and systemic cyclosporine. For cataract extraction he would use phacoemulsification with a large anterior capsulotomy. Intensive perioperative and postoperative inflammation control is necessary. He is in favor of a two stage procedure for the treatment of cataract and glaucoma. He will use mitomycine with the trabeculectomy. Cataract surgery follows some months after the surgery. Rockwood follows the same lines of thought as far as medical treatment is concerned. He is very much in favor of a combined procedure. He will use mitomycine-C. The authors discuss how to approach a small pupil. Finally Caprioli stresses again that the uveitis should be well controlled before cataract surgery is performed. He is very much in favor of using draining implants. He also cautions too much manipulation of the pupil because of resulting in inflammation. He stresses the perioperative steroid treatment including systemic corticosteroids. In the case of the left eye with high intraocular pressure and considerable cataract he would do glaucoma drainage implant first followed by cataract extraction.
UCLA Jules Stein Eye Institute, Los Angeles, California 90095, USA.
Classification:
9.4.6 Glaucomas associated with inflammation, uveitis (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)