Glaucoma in patients with uveitis

The records of 100 patients (161 eyes) with uveitis were reviewed retrospectively to determine the prevalence of increased intraocular pressure, the forms of uveitis most commonly associated with glaucoma, and the forms that require specific glaucoma therapy. Secondary glaucoma was present in 23 patients (31 eyes): three of 24 patients with acute uveitis (three eyes, 12% of acute uveitis patients) and 20 of 76 patients with chronic uveitis (28 eyes, 26% of chronic uveitis patients). Eighteen patients (26 eyes, 78% of glaucoma patients) with chronic uveitis required long-term medical therapy to control intraocular pressure. Three patients (three eyes, 12% of glaucoma patients) with acute uveitis required short-term therapy to control intraocular pressure. The remaining two patients had transient increases in intraocular pressure that did not require treatment or that responded to treatment of intraocular inflammation alone. One patient with chronic uveitis (two eyes, 4% of glaucoma patients) required filtering surgery. At least five patients (eight eyes, 22% of glaucoma patients) had glaucomatous visual field defects. The results of this survey are consistent with the concept that secondary glaucoma is a management problem in patients with anterior segment inflammation and chronic rather than acute uveitis. An algorithm for the management of increased intraocular pressure in patients with uveitis is proposed.