Pathogenesis and Current Methods of Treatment of Secondary Uveitic Glaucoma. A Review

Abstract

Secondary uveitic glaucoma is a serious sight-threatening complication of intraocular inflammation (uveitis). It develops in approximately 10–20% of patients with uveitis (although this figure may be higher depending on the type of inflammation). It is more commonly associated with chronic forms of uveitis, especially anterior uveitis. Elevation of intraocular pressure (IOP) and the development of secondary glaucoma arise as a direct or indirect consequence of uveitis, and may develop further in association with therapy for intraocular inflammation. Several types of uveitic glaucoma are distinguished according to the mechanism of development: open-angle secondary glaucoma (including steroid-induced secondary glaucoma), angle-closure secondary glaucoma, and a combination of both. It is necessary to determine the pathogenesis of uveitis and target the treatment of the inflammatory process according to it. Subsequently, it is necessary to determine the type of secondary glaucoma, which influences the choice of therapy. Compensation for IOP should be achieved as quickly as possible, before irreversible damage to the optic nerve and visual field occurs. In the first instance, we choose conservative pharmacological therapy. However, this therapy fails more often in secondary uveitic glaucoma than in primary open-angle glaucoma. For this reason, surgical or laser therapy is necessary for refractory glaucoma. Trabeculectomy remains the gold standard in surgical therapy for secondary uveitic glaucoma, but other surgical techniques can also be used (Ahmed drainage implants, goniotomy in the paediatric population, surgical iridectomy, and synechiae for angle closure etc.). The choice of method is individualised according to the clinical findings of the patient and previous ocular procedures. However, the main factor influencing the success and efficacy of filtration surgery is adequate therapy and control of the intraocular inflammatory process.