Ocular hypertension can rapidly progress to uveitic glaucoma, according to researchers in New Zealand. Due to its aggressive nature, uveitic glaucoma will likely require surgical intervention to prevent central vision loss. 

To examine presentation, management, and long-term effects of ocular hypertension and uveitic glaucoma, investigators conducted a retrospective observational study of patients with uveitic glaucoma or ocular hypertension seen in Auckland, New Zealand, spanning the last 10 years. Patients were included in the study if they had intraocular pressures (IOP) of at least 24 mm Hg that required treatment with ocular antihypertensive agents for at least 3 months or if they developed glaucoma secondary to uveitis.

A total of 188 eyes of 139 patients with uveitic glaucoma or ocular hypertension were included in the study. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years, and 52.5% of patients were men. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median IOP at diagnosis was 35 mm Hg (IQR 29–45). Findings show that 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, while 50 eyes underwent trabeculectomy, 18 eyes required a tube, and 6 underwent minimally invasive glaucoma surgery (MIGS).


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“OHT in patients with uveitis can develop from multiple mechanisms and is related to the inflammatory effects of uveitis as well as steroid treatment of uveitis,” according to the study. “It has a high rate of converting to UG, with more than three-quarters of patients in this study developing GON over the study period.”

The research team recommends close collaboration among uveitis and glaucoma specialists for the best outcomes.

Reference

Ma T, Sims JL, Bennett S, et al. High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis. Br J Ophthalmol. Published online May 21, 2021. doi:10.1136/bjophthalmol-2021-318809