Further Outpatient Care
- Patients should receive follow-up care as needed.
Inpatient & Outpatient Medications
- See Medication.
Complications
- Complications of uveitis include the following:
- Band keratopathy
- Corneal decompensation
- Posterior subcapsular cataract
- Vitreous opacities
- Retinal or choroidal detachment
- Macular edema
- Disc edema
- Postoperative complications include the following:
- Postoperative complications (eg, choroidal effusion, choroidal hemorrhage, shallow anterior chamber, hypotony) may be higher in eyes with uveitic glaucoma than with primary open-angle glaucoma after trabeculectomy with wound modulation.
- Postoperative inflammation is fairly common in eyes with uveitic glaucoma, although this incidence can be lowered by treating the patients with preoperative and postoperative corticosteroids.
- The combination of postoperative inflammation and shallow anterior chamber can lead to the formation of PAS, which may interfere with the function of the glaucoma filter. Cataract formation also is very common with this scenario; therefore, prolonged periods of postoperative shallowing of the anterior chamber should be avoided.
- Phthisis bulbi may occur after any surgical procedure for uveitic glaucoma but is particularly common after cycloablative therapy. Eyes that may be at high risk of developing phthisis include those with a totally occluded angle and a relatively low preoperative IOP.
Prognosis
- Outcome and prognosis of surgery
- Few published reports are available that address the results of surgery in patients with uveitic glaucoma.
- Hoskins et al achieved successful lowering of IOP in 6 of 9 eyes undergoing trabeculectomy for uveitic glaucoma.[8]
- Hill et al showed a success rate of 81% at 12 months. The success rate of trabeculectomy with antimetabolite supplementation has been reported to be higher (71-100%).[9]
- Wright et al reported that 3 of 24 patients undergoing trabeculectomy with mitomycin-C required subsequent drainage implants and that 7 of 24 patients lost 2 or more lines of Snellen acuity.[10]
- Hill et al reported a success rate of 79% of eyes undergoing Molteno tube implantation.[11]
- Ceballos et al reported a success rate of 91.7% in eyes undergoing Baerveldt drainage device placement for uveitic glaucoma.[12]
- Ozdal et al showed a 2-year success rate of 60% in eyes undergoing Ahmed drainage device placement for uveitic glaucoma.[13]
- Rachmiel et al reported similar 30-month results between eyes that underwent Ahmed glaucoma valve implantation with uveitic glaucoma compared to open-angle glaucoma eyes.[14]
Patient Education
- For patient education resources, see the Glaucoma Center and Eye and Vision Center, as well as Glaucoma Overview, Anatomy of the Eye, Glaucoma FAQs, Understanding Glaucoma Medications, and Iritis.
Callanan DG, Jaffe GJ, Martin DF, Pearson PA, Comstock TL. Treatment of posterior uveitis with a fluocinolone acetonide implant: three-year clinical trial results. Arch Ophthalmol. Sep 2008;126(9):1191-201. [Medline].
Bollinger K, Kim J, Lowder CY, Kaiser PK, Smith SD. Intraocular pressure outcome of patients with fluocinolone acetonide intravitreal implant for noninfectious uveitis. Ophthalmology. Oct 2011;118(10):1927-31. [Medline].
Hunter RS, Lobo AM. Dexamethasone intravitreal implant for the treatment of noninfectious uveitis. Clin Ophthalmol. 2011;5:1613-21. [Medline].
Kempen JH, Altaweel MM, Holbrook JT, Jabs DA, Louis TA, Sugar EA, et al. Randomized comparison of systemic anti-inflammatory therapy versus fluocinolone acetonide implant for intermediate, posterior, and panuveitis: the multicenter uveitis steroid treatment trial. Ophthalmology. Oct 2011;118(10):1916-26. [Medline]. [Full Text].
Malone PE, Herndon LW, Muir KW, Jaffe GJ. Combined fluocinolone acetonide intravitreal insertion and glaucoma drainage device placement for chronic uveitis and glaucoma. Am J Ophthalmol. May 2010;149(5):800-6.e1. [Medline].
Horsley MB, Chen TC. The use of prostaglandin analogs in the uveitic patient. Semin Ophthalmol. Jul-Sep 2011;26(4-5):285-9. [Medline].
Markomichelakis NN, Kostakou A, Halkiadakis I, Chalkidou S, Papakonstantinou D, Georgopoulos G. Efficacy and safety of latanoprost in eyes with uveitic glaucoma. Graefes Arch Clin Exp Ophthalmol. Jun 2009;247(6):775-80. [Medline].
Hoskins DH, Hetherington J, Shaffer RN. Surgical management of the inflammatory glaucomas. Perspect Ophthalmol. 1977;1:173-81.
Hill RA, Nguyen QH, Baerveldt G, et al. Trabeculectomy and Molteno implantation for glaucomas associated with uveitis. Ophthalmology. Jun 1993;100(6):903-8. [Medline].
Wright MM, McGehee RF, Pederson JE. Intraoperative mitomycin-C for glaucoma associated with ocular inflammation. Ophthalmic Surg Lasers. May 1997;28(5):370-6. [Medline].
Hill RA, Heuer DK, Baerveldt G, et al. Molteno implantation for glaucoma in young patients. Ophthalmology. Jul 1991;98(7):1042-6. [Medline].
Ceballos EM, Parrish RK, Schiffman JC. Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma. Ophthalmology. Dec 2002;109(12):2256-60. [Medline].
Ozdal PC, Vianna RN, Deschenes J. Ahmed valve implantation in glaucoma secondary to chronic uveitis. Eye. Feb 2006;20(2):178-83. [Medline].
Rachmiel R, Trope GE, Buys YM, Flanagan JG, Chipman ML. Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients. Can J Ophthalmol. Aug 2008;43(4):462-7. [Medline].
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