Uveitic glaucoma

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Uveitic Glaucoma
Other namesUveitis Glaucoma, Anterior Uveitic Glaucoma, Anterior Non-Infectious Uveitic Glaucoma, Uveitis Associated with Glaucoma, Iritic Glaucoma
Hypopyon.jpg
Hypopyon in anterior uveitis, seen as yellowish exudation in lower part of anterior chamber of eye
Pronunciation
Specialty Ophthalmology, optometry, immunology
Symptoms Pain, blurry vision, headache, light sensitivity, eye redness, "floaters", decreased vision, blindness
Types Visual impairment
Causes Uveitis, Glucocorticoid treatment for uveitis

Uveitic glaucoma (or uveitis glaucoma, or anterior uveitic glaucoma, or anterior noninfectious uveitic glaucoma, or uveitis associated with glaucoma, or iritic glaucoma) is most commonly a progression stage of noninfectious anterior uveitis or iritis.

Contents

Noninfectious anterior uveitis is an inflammation of the anterior (front) part of the eye and is instigated by autoimmune or other noninfectious causes (noninfectious uveitis can also affect the posterior segments of the eye, and then is called posterior, pan or intermediate uveitis). The onset of noninfectious uveitis occurs in patients in their thirties, [1] with up to 10% of cases diagnosed in children under the age of 16. [2] [3] The condition may persist as a chronic disease.

Noninfectious uveitis is the most common form of uveitis in developed countries. Approximately 30% of uveitis patients develop glaucoma [4] [5] as a result of the inflammation that occurs in uveitis, as a complication of steroid treatment [6] or a combination of both. [4]

Uveitis, as well as steroid treatment for uveitis, can cause an increased resistance to the flow of aqueous humour (the clear liquid suspended between the lens and the cornea) from the eye. This leads to an excess of fluid buildup, which exerts elevated pressure on the inside parts of the eye, or elevated intraocular pressure (IOP). Elevated intraocular pressure can in turn lead to optic nerve damage and glaucoma.

Based on epidemiological studies of uveitis, approximately 34-94/100,000 people will develop uveitic glaucoma (see Epidemiology section). Uveitic glaucoma patients are at significantly higher risk for visual field loss in the long term compared to patients who only have uveitis. Patients with uveitic glaucoma also experience a particularly high burden of care. [7]

Signs and symptoms [4] [8]

Because uveitic glaucoma is a progressive stage of anterior non infectious uveitis, uveitic glaucoma involves signs and symptoms of both glaucoma and uveitis.

Patients with acute non infectious anterior uveitis may experience the following symptoms: pain, blurry vision, headache, photophobia (discomfort or pain due to light exposure), or the observance of haloes around lights.

An ophthalmologist may be able to observe the main sign of active noninfectious anterior uveitis, which is the presence of immune cells (anterior chamber cells, or ACCs) floating within the anterior segment of the eye (see "Noninfectious anterior uveitis" in Diagnosis section). The ophthalmologist also may observe peripheral anterior synechiae (PAS), or adhesions between the iris and trabecular meshwork, the tissue responsible for draining aqueous humour from the eye. [4]

Patients with uveitis who also experience symptoms of glaucoma may have uveitic glaucoma.

In an eye with uveitic glaucoma, the following glaucoma signs may be observed: elevated intraocular pressure, scotomas in the field of vision, defects in the fiber layer of the retinal nerve, and/or excavation (a regional deformation or depression of the optic nerve). Pupillary blocks, or the obstruction of "the flow of aqueous humor from the posterior chamber to the anterior chamber" due to a "functional block between the pupillary portion of the iris and the lens" [9] may also be detected. Finally, the ophthalmologist may observe peripheral anterior synechiae (PAS), or adhesions between the iris and trabecular meshwork. [10]

The dual presence of glaucoma and uveitis symptoms points to a diagnosis of uveitic glaucoma.

Causes

Uveitic glaucoma is a progressive stage of anterior noninfectious uveitis. Patients diagnosed with anterior noninfectious uveitis may also develop glaucoma; in this case the condition is termed uveitic glaucoma. Uveitic glaucoma can arise from the inflammation that occurs in uveitis; from steroid treatment for uveitis; [6] or a combination of both. [4]

Uveitis inflammation

The inflammatory response associated with uveitis may lead to glaucoma. [4] Active anterior uveitis flare-ups may develop quickly; in these cases, the inflammation can damage the tissues in the front part of the eye. Anterior uveitis may also be chronic; in these cases, repeated inflammation can cause progressive, accumulating damage to the eye tissues.

In all cases — acute one-time episodes, recurrent chronic inflammation or acute-on-chronic inflammation — damage to the eye tissues can cause increased resistance to the outflow of aqueous humour from the eye, which then increases the pressure inside the eye. In some chronic uveitis cases, the pressure inside the eye waxes and wanes due to the uveitis flare-ups. [11]

Elevated pressure inside the eye can lead to irreversible optic nerve damage and glaucoma.

Steroid treatment for uveitis

Topical corticosteroids are the first-line treatment for an active flare-up of noninfectious anterior uveitis, and the only effective treatment available for active inflammation. [12] However, steroid treatment for uveitis can lead to uveitic glaucoma. [13] Corticosteroids increase the fluid pressure inside the eye by increasing resistance to the outflow of aqueous humour, which can cause optic nerve damage and glaucoma. Steroid treatment can therefore cause or worsen uveitic glaucoma. [6]

Elevated pressure inside the eye typically develops 2 to 6 weeks after starting corticosteroid therapy, but can occur at any time during corticosteroid therapy and may continue for weeks after steroid use has been stopped. [12] According to the Glaucoma Research Foundation, the risk of developing chronic steroid-induced glaucoma increases with every week of steroid use. [14]

Around 90% of patients with open angle glaucoma experience a steroid response of elevated intraocular pressure following steroid treatment. [14] Therefore, once uveitis patients have developed uveitic glaucoma, they should ideally avoid steroids wherever possible.

Combination of uveitis inflammation and steroid treatment

In some cases, uveitis inflammation and steroid treatment both contribute to elevated pressure inside the eye, which leads to optic nerve damage and glaucoma. [4]

Pathogenesis [15]

Uveitic glaucoma as a result of recurring uveitic inflammation

Uveitic glaucoma can develop as a complication of anterior uveitis resulting from the inflammatory response associated with the disease. [4] The inflammatory response can be characterized by occlusion of the trabecular meshwork, or blocking of the tissue that is responsible for draining aqueous humour from the eye. Another characteristic that presents in some patients is peripheral anterior synechiae (PAS), or adhesions between the iris and trabecular meshwork. [10] These two characteristics of the inflammatory uveitic response can lead to an increase in intraocular pressure, and consequently to irreversible optic nerve damage and glaucoma.

Noninfectious uveitis is characterized by an inflammatory process that may be acute, recurrent, chronic or acute-on-chronic. Uveitic glaucoma is associated with an aggressive disease course caused by very high levels of intraocular pressure that wax and wane. [11] When uveitis is acute, the onset of inflammation is rapid, with obstruction of intertrabecular spaces. [4] When uveitis is chronic, recurrent bouts lead to tissue destruction from direct inflammation. [4] Obstruction of the intertrabecular spaces characteristic of acute onset uveitis, as well as the repeated inflammation characteristic to chronic uveitis, can lead to elevated intraocular pressure. This can consequently cause optic nerve damage and glaucoma.

Uveitic glaucoma as a response to steroid treatment of uveitis

Uveitic glaucoma can also develop as a response to steroid treatment of uveitis. [13] Corticosteroids cause a rise in the fluid pressure inside the eye. While the pathogenesis of corticosteroid-induced ocular hypertension is not fully understood, it likely involves swelling and remodeling (alterations to the extracellular matrix [16] ) of the trabecular meshwork, which leads to increased resistance to aqueous humour outflow and an increase in intraocular pressure. Another possible mechanism by which corticosteroids increase fluid pressure inside the eye is as follows:

  1. Corticosteroids inhibit (partly prevent and slow) the breakdown of glycosaminoglycans (GAGs) in the trabecular meshwork.
  2. GAGs accumulate in the meshwork.
  3. Fluid drainage is decreased.
  4. Fluid pressure in the eye is increased.

It has also been suggested that corticosteroids may be capable of modifying the trabecular meshwork cells, modulating their size as well as their cytoskeletal arrangement, which in turn could limit fluid drainage. [15]

Diagnosis

Uveitic glaucoma is a progression stage of noninfectious acute anterior uveitis. In order to diagnose uveitic glaucoma, a dual diagnosis of non-infectious anterior uveitis and glaucoma is required. A thorough examination of the eye by an ophthalmologist is performed in order to diagnose uveitic glaucoma. [4]

Noninfectious anterior uveitis [17] [18]

[ Main article: Uveitis]

Demonstration of anterior chamber cells (ACCs) indicative of noninfectious anterior uveitis, as represented visually by the Tarsier Grading Image Scale (TGIS). Immune cells are represented by white dots. ACC Anterior Chamber Cell Grading Scale.png
Demonstration of anterior chamber cells (ACCs) indicative of noninfectious anterior uveitis, as represented visually by the Tarsier Grading Image Scale (TGIS). Immune cells are represented by white dots.

The main diagnostic sign of noninfectious acute anterior uveitis is the presence of anterior chamber cells (ACCs), or immune cells, in the anterior, or front, chamber of the eye. The anterior chamber of healthy eyes does not contain any immune cells, hence the main indicator of noninfectious anterior uveitis is the presence of immune blood cells inside the anterior chamber of the eye. The more cells found floating in the anterior chamber, the more severe the uveitis. [17]

The quantity of immune cells present in the anterior chamber can be determined via a slit lamp examination. [18]

In 2005, an International Working Group on SUN (Standardization of Uveitis Nomenclature) took steps towards standardizing the methods for reporting clinical data in the field of uveitis. One of their products was a grading scheme for anterior chamber cells.

In 2021, a new slit lamp–based ACC assessment method, TGIS (Tarsier Grading Image Scale), was developed. [18] TGIS uses a visual analog scale to enable pattern recognition-based evaluation of ACC density during a uveitic flare-up. This is achieved by graphically representing a high-power field slit beam through the anterior chamber, from the cornea to the lens surface.

Another important clinical measurement of ocular inflammation is flare. Flare is the leakage of various proteins (such as fibrin and cytokines) into the ocular anterior chamber, as a manifestation of inflammation. It will usually have a "milky" appearance. Flare can also be observed via slit lamp examination. [20]

Glaucoma

[ Main article: Glaucoma]

Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina [21] ) and cause vision loss. [22]

Glaucoma is challenging to diagnose and relies on several different methods of assessment to determine the level of optic nerve damage. [23] These may include tonometry, a procedure to determine pressure inside the eye; a visual field test, which assesses peripheral vision; and imaging tests of the optic nerve. [24]

Treatment

Treatment for uveitic glaucoma requires addressing the noninfectious anterior uveitis as well as the glaucoma present in uveitic glaucoma patients. Most urgently, the inflammation associated with uveitis must be identified and treated, to ensure as little damage to the eye as possible. Secondly, the elevated intraocular pressure associated with glaucoma must be treated. Steroid treatment may be discouraged because of the associated side effects. [4]

Treatment of noninfectious anterior uveitis

Topical corticosteroid eyedrops are first-line treatment for uveitis and represent the only approved topical treatment for active non-infectious anterior uveitis. [25] They are the only effective treatment for the short term available today. [26] [12] Corticosteroids can also be administered via periocular injection or intravitreal (IVT) injection. In more severe cases, treatment may be administered systemically via oral or intravenous corticosteroids.

Other treatments, including systemic immunosuppressive agents — which require close monitoring — may be considered where corticosteroids are ineffective or if there are concerns regarding side effects. Immunosuppressive agents include T-cell inhibitors such as cyclosporine and tacrolimus; antimetabolites such as azathioprine, methotrexate, mycophenolate mofetil, and leflunomide; alkylating agents such as cyclophosphamides and chlorambucil; and biological drugs such as adalimumab.

Most uveitis patients are treated with local steroids in the acute phase but may also need long-term treatment with lower-dose steroids as a preventive measure between flare-ups. This precaution is employed in order to minimize the use of topical corticosteroids, due to their severe ocular side effects.

Despite significant advances in therapeutics, the prevalence of blindness secondary to uveitis has not been reduced in the U.S. for the past 30 years. [27] [28]

Steroid treatment for uveitis can lead to uveitic glaucoma. [6] Corticosteroids increase the fluid pressure inside the eye (by increasing the resistance to the outflow of aqueous humour), which can cause optic nerve damage and glaucoma. Steroid treatment can therefore cause or worsen uveitic glaucoma. [6]

Studies show that 40% to 50% of patients treated with the corticosteroid triamcinolone via intravitreal injection developed clinically significant ocular hypertension. [12] Corticosteroid-induced ocular hypertension typically develops 2 to 6 weeks after starting therapy but can occur at any time during corticosteroid therapy and may persist for weeks after corticosteroids have been discontinued. [12] According to the Glaucoma Research Foundation, "every week of steroid use averaged over a lifetime leads to a 4% increased risk of chronic steroid[-induced] glaucoma". [29]

In addition, around 90% of patients with pre-existing open angle glaucoma develop an additional adverse response to steroid treatment. [14]

Treatment of uveitic glaucoma

Glaucoma medications, glaucoma surgery and steroids are the primary options for addressing uveitic glaucoma. Approximately 30% of uveitic glaucoma patients require surgical intervention due to insufficient intraocular pressure control while on maximum medicinal therapy. [30]

Available surgical interventions to treat the glaucoma in uveitic glaucoma patients pose a high risk to the eye, with a lower success rate compared to glaucoma surgeries in non-uveitic eyes. [31] [32] Steroids for treating uveitic glaucoma patients also carry high risks.

Because of the risks inherent in steroid treatment and the ineffectiveness of surgical interventions for uveitic glaucoma, [31] [32] there is currently no approved treatment for uveitic patients who also have glaucoma.

A steroid-free medication for uveitis in uveitic glaucoma patients, formulated by Tarsier Pharma, is currently undergoing clinical trials [see Research section]. [33]

Uveitic glaucoma patients respond poorly to glaucoma surgery; surgery in uveitic glaucoma patients commonly has complications. [34] [35] These complications are caused by either the surgical wound healing improperly or unhealthy levels of pressure inside the eye. [11]

Glaucoma surgery usually leads to increased levels of inflammation in the eyes. This is an undesirable consequence, especially in uveitis patients, who already have a high tendency to develop inflammation. Because of this, 80% of uveitis experts report that glaucoma surgeries for uveitic glaucoma patients are likely to fail. [7] Surgery in an eye with uveitis is associated with a higher complication rate, and in some cases surgeries such as valve implantation are too complicated to perform. [34] [35]

Prognosis for uveitic glaucoma patients [7]

About 30% of uveitis patients also develop uveitic glaucoma. Uveitic glaucoma patients are at significantly higher risk for visual field loss in the long term (>5 years) compared to patients who only have uveitis. A patient who only has glaucoma (without uveitis) will, on average, become blind in one eye within 20 years of glaucoma onset. [7] This is especially devastating given that the majority of uveitic glaucoma patients are diagnosed with uveitis at a relatively young age (in their thirties). [1] Thus developing glaucoma at a young age and the cumulative damage of uveitis flare-ups put these patients at high risk of losing their eyesight.

The burden of care for uveitis glaucoma patients is also higher than that of uveitis patients without glaucoma. On average, doctors report 60% more visits from uveitic glaucoma patients than non-glaucomatous uveitis patients. Doctor visits are 40% longer for patients with uveitic glaucoma than for uveitis patients without glaucoma. [7]

Epidemiology [36] [37] [38]

According to epidemiological studies, the prevalence of uveitis is estimated at 115-316 occurrences in 100,000 people in the United States. [36] About 30% of patients with non-infectious anterior uveitis also develop glaucoma. [4] [5] Accordingly, 34-94 people in every 100,000 patients in the United States with uveitis will develop glaucoma.

Research

Steroid-free medication for uveitis and uveitic glaucoma [33] [39]

A steroid-free eyedrop medication for uveitis and uveitic glaucoma patients, TRS01, is undergoing clinical investigation (as of May 2022). TRS01 is intended as an anti-inflammatory medication for uveitis and uveitic glaucoma that is not anticipated to contribute to elevated intraocular pressure and glaucoma. Up to May 2022, two Phase I/II clinical trials testing TRS01 have been completed. Several dozen patients have undergone these trials. TRS01 is now being investigated in a Phase III clinical trial in patients with noninfectious anterior uveitis, including some with uveitic glaucoma. [33]

Related Research Articles

<span class="mw-page-title-main">Glaucoma</span> Group of eye diseases

Glaucoma is a group of eye diseases that lead to damage of the optic nerve, which transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or medications. The word glaucoma comes from the Ancient Greek word γλαυκóς, meaning 'gleaming, blue-green, gray'.

The National Eye Institute (NEI) is part of the U.S. National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services. The mission of NEI is "to eliminate vision loss and improve quality of life through vision research." NEI consists of two major branches for research: an extramural branch that funds studies outside NIH and an intramural branch that funds research on the NIH campus in Bethesda, Maryland. Most of the NEI budget funds extramural research.

<span class="mw-page-title-main">Uveitis</span> Inflammation of the uvea of the eye

Uveitis is inflammation of the uvea, the pigmented layer of the eye between the inner retina and the outer fibrous layer composed of the sclera and cornea. The uvea consists of the middle layer of pigmented vascular structures of the eye and includes the iris, ciliary body, and choroid. Uveitis is described anatomically, by the part of the eye affected, as anterior, intermediate or posterior, or panuveitic if all parts are involved. Anterior uveitis (iridocyclitis) is the most common, with the incidence of uveitis overall affecting approximately 1:4500, most commonly those between the ages of 20-60. Symptoms include eye pain, eye redness, floaters and blurred vision, and ophthalmic examination may show dilated ciliary blood vessels and the presence of cells in the anterior chamber. Uveitis may arise spontaneously, have a genetic component, or be associated with an autoimmune disease or infection. While the eye is a relatively protected environment, its immune mechanisms may be overcome resulting in inflammation and tissue destruction associated with T-cell activation.

<span class="mw-page-title-main">Intraocular pressure</span> Fluid pressure inside the eye

Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated to measure pressure in millimeters of mercury (mmHg).

<span class="mw-page-title-main">Hyphema</span> Hemorrhage in the front chamber of the eye

Hyphema is the medical condition of bleeding in the anterior chamber of the eye between the iris and the cornea. People usually first notice a loss or decrease in vision. The eye may also appear to have a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris in the cornea. A traumatic hyphema is caused by a blow to the eye. A hyphema can also occur spontaneously.

<span class="mw-page-title-main">Anterior chamber of eyeball</span> Space in the eye

The anterior chamber (AC) is the aqueous humor-filled space inside the eye between the iris and the cornea's innermost surface, the endothelium. Hyphema, anterior uveitis and glaucoma are three main pathologies in this area. In hyphema, blood fills the anterior chamber as a result of a hemorrhage, most commonly after a blunt eye injury. Anterior uveitis is an inflammatory process affecting the iris and ciliary body, with resulting inflammatory signs in the anterior chamber. In glaucoma, blockage of the trabecular meshwork prevents the normal outflow of aqueous humour, resulting in increased intraocular pressure, progressive damage to the optic nerve head, and eventually blindness.

<span class="mw-page-title-main">Schlemm's canal</span> Lymphatic-like vessel in the eye

Schlemm's canal is a circular lymphatic-like vessel in the eye. It collects aqueous humor from the anterior chamber and delivers it into the episcleral blood vessels. Canaloplasty may be used to widen it.

Ocular hypertension is the presence of elevated fluid pressure inside the eye, usually with no optic nerve damage or visual field loss.

<span class="mw-page-title-main">Loteprednol</span> Pharmaceutical drug

Loteprednol is a topical corticosteroid used to treat inflammations of the eye. It is marketed by Bausch and Lomb as Lotemax and Loterex.

<span class="mw-page-title-main">Glaucoma surgery</span> Type of eye surgery

Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor.

<span class="mw-page-title-main">Intermediate uveitis</span> Medical condition

Intermediate uveitis is a form of uveitis localized to the vitreous and peripheral retina. Primary sites of inflammation include the vitreous of which other such entities as pars planitis, posterior cyclitis, and hyalitis are encompassed. Intermediate uveitis may either be an isolated eye disease or associated with the development of a systemic disease such as multiple sclerosis or sarcoidosis. As such, intermediate uveitis may be the first expression of a systemic condition. Infectious causes of intermediate uveitis include Epstein–Barr virus infection, Lyme disease, HTLV-1 virus infection, cat scratch disease, and hepatitis C.

Pseudoexfoliation syndrome, often abbreviated as PEX and sometimes as PES or PXS, is an aging-related systemic disease manifesting itself primarily in the eyes which is characterized by the accumulation of microscopic granular amyloid-like protein fibers. Its cause is unknown, although there is speculation that there may be a genetic basis. It is more prevalent in women than men, and in persons past the age of seventy. Its prevalence in different human populations varies; for example, it is prevalent in Scandinavia. The buildup of protein clumps can block normal drainage of the eye fluid called the aqueous humor and can cause, in turn, a buildup of pressure leading to glaucoma and loss of vision. As worldwide populations become older because of shifts in demography, PEX may become a matter of greater concern.

Micro-invasive glaucoma surgery (MIGS) is the latest advance in surgical treatment for glaucoma, which aims to reduce intraocular pressure by either increasing outflow of aqueous humor or reducing its production. MIGS comprises a group of surgical procedures which share common features. MIGS procedures involve a minimally invasive approach, often with small cuts or micro-incisions through the cornea that causes the least amount of trauma to surrounding scleral and conjunctival tissues. The techniques minimize tissue scarring, allowing for the possibility of traditional glaucoma procedures such as trabeculectomy or glaucoma valve implantation to be performed in the future if needed.

<span class="mw-page-title-main">Vogt–Koyanagi–Harada disease</span> Medical condition

Vogt–Koyanagi–Harada disease (VKH) is a multisystem disease of presumed autoimmune cause that affects melanin-pigmented tissues. The most significant manifestation is bilateral, diffuse uveitis, which affects the eyes. VKH may variably also involve the inner ear, with effects on hearing, the skin, and the meninges of the central nervous system.

<span class="mw-page-title-main">Secondary glaucoma</span>

Secondary glaucoma is a collection of progressive optic nerve disorders associated with a rise in intraocular pressure (IOP) which results in the loss of vision. In clinical settings, it is defined as the occurrence of IOP above 21 mmHg requiring the prescription of IOP-managing drugs. It can be broadly divided into two subtypes: secondary open-angle glaucoma and secondary angle-closure glaucoma, depending on the closure of the angle between the cornea and the iris. Principal causes of secondary glaucoma include optic nerve trauma or damage, eye disease, surgery, neovascularization, tumours and use of steroid and sulfa drugs. Risk factors for secondary glaucoma include uveitis, cataract surgery and also intraocular tumours. Common treatments are designed according to the type and the underlying causative condition, in addition to the consequent rise in IOP. These include drug therapy, the use of miotics, surgery or laser therapy.

Schwartz–Matsuo syndrome is a human eye disease characterised by rhegmatogenous retinal detachment, elevated intraocular pressure (IOP) and open angle of anterior chamber.

Uveitis–glaucoma–hyphaema (UGH) syndrome, also known as Ellingson syndrome, is a complication of cataract surgery, caused by intraocular lens subluxation or dislocation. The chafing of mispositioned intraocular lens over iris, ciliary body or iridocorneal angle cause elevated intraocular pressure (IOP) anterior uveitis and hyphema. It is most commonly caused by anterior chamber IOLs and sulcus IOLs but, the condition can be seen with any type of IOL, including posterior chamber lenses and cosmetic iris implants.

Posner–Schlossman syndrome (PSS) also known as glaucomatocyclitic crisis (GCC) is a rare acute ocular condition with unilateral attacks of mild granulomatous anterior uveitis and elevated intraocular pressure. It is sometimes considered as a secondary inflammatory glaucoma.

Ghost cell glaucoma (GCG) is a type of secondary glaucoma occurs due to long standing vitreous hemorrhage. The rigid and less pliable degenerated red blood cells block the trabecular meshwork and increase the pressure inside eyes.

Panuveitis also known as Diffuse uveitis or Total uveitis is an eye disease affecting the internal structures of the eye. In this inflammation occurs throughout the uveal tract, with no specific areas of predominant inflammation. In most cases, along with the uvea, the retina, vitreous humor, optic nerve or lens are also involved.

References

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  21. ↑ Davis, Benjamin Michael; Crawley, Laura; Pahlitzsch, Milena; Javaid, Fatimah; Cordeiro, Maria Francesca (December 2016). "Glaucoma: the retina and beyond". Acta Neuropathologica. 132 (6): 807–826. doi:10.1007/s00401-016-1609-2. ISSN   1432-0533. PMC   5106492 . PMID   27544758.
  22. ↑ "Glaucoma | National Eye Institute". www.nei.nih.gov. Retrieved 2022-04-29.
  23. ↑ "GLAUCOMA". Uveitic Glaucoma. Retrieved 2022-03-17.
  24. ↑ "Glaucoma". WebMD. Retrieved 2022-03-17.
  25. ↑ Babu, Kalpana; Mahendradas, Padmamalini (June 2013). "Medical management of uveitis - current trends". Indian Journal of Ophthalmology. 61 (6): 277–283. doi: 10.4103/0301-4738.114099 . ISSN   1998-3689. PMC   3744780 . PMID   23803479.
  26. ↑ "Patient Guides". Uveitis.org | OIUF. Retrieved 2022-06-01.
  27. ↑ Nussenblatt, R. B. (October 1990). "The natural history of uveitis". International Ophthalmology. 14 (5–6): 303–308. doi:10.1007/BF00163549. ISSN   0165-5701. PMID   2249907. S2CID   30599014.
  28. ↑ Siddique, Sana S.; Suelves, Ana M.; Baheti, Ujwala; Foster, C. Stephen (2013-01-01). "Glaucoma and Uveitis". Survey of Ophthalmology. 58 (1): 1–10. doi:10.1016/j.survophthal.2012.04.006. ISSN   0039-6257. PMID   23217584.
  29. ↑ MD, Terri-Diann Pickering (2022-03-22). "Steroids and Glaucoma: What's the Connection? | glaucoma.org". glaucoma.org. Retrieved 2022-05-26.
  30. ↑ Kalin-Hajdu, Evan; Hammamji, Karim; Gagné, Sébastien; Harasymowycz, Paul (October 2014). "Outcome of viscodilation and tensioning of Schlemm's canal for uveitic glaucoma". Canadian Journal of Ophthalmology. Journal Canadien d'Ophtalmologie. 49 (5): 414–419. doi:10.1016/j.jcjo.2014.07.001. ISSN   1715-3360. PMID   25284096.
  31. 1 2 "Retisert (fluocinolone acetonide intravitreal implant) 0.59 mg: Bausch + Lomb". www.bausch.com. Retrieved 2022-03-24.
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  34. 1 2 Tan, Annelie N.; Cornelissen, Michiel F.; Webers, Carroll A. B.; Erckens, Roel J.; Berendschot, Tos T. J. M.; Beckers, Henny J. M. (February 2018). "Outcomes of severe uveitic glaucoma treated with Baerveldt implant: can blindness be prevented?". Acta Ophthalmologica. 96 (1): 24–30. doi: 10.1111/aos.13489 . ISSN   1755-3768. PMID   28921906. S2CID   25374158.
  35. 1 2 Ceballos, Elizenda M.; Parrish, Richard K.; Schiffman, Joyce C. (December 2002). "Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma". Ophthalmology. 109 (12): 2256–2260. doi:10.1016/s0161-6420(02)01294-0. ISSN   0161-6420. PMID   12466167.
  36. 1 2 Thorne, Jennifer E.; Suhler, Eric; Skup, Martha; Tari, Samir; Macaulay, Dendy; Chao, Jingdong; Ganguli, Arijit (2016-11-01). "Prevalence of Noninfectious Uveitis in the United States: A Claims-Based Analysis". JAMA Ophthalmology. 134 (11): 1237–1245. doi: 10.1001/jamaophthalmol.2016.3229 . ISSN   2168-6173. PMID   27608193.
  37. ↑ Gritz, D (March 2004). "Incidence and prevalence of uveitis in Northern California The Northern California Epidemiology of Uveitis Study". Ophthalmology. 111 (3): 491–500. doi:10.1016/j.ophtha.2003.06.014. ISSN   0161-6420. PMID   15019324.
  38. ↑ Zhang, Youning; Amin, Sarina; Lung, Khristina I.; Seabury, Seth; Rao, Narsing; Toy, Brian C. (2020-08-25). Wang, I-Jong (ed.). "Incidence, prevalence, and risk factors of infectious uveitis and scleritis in the United States: A claims-based analysis". PLOS ONE. 15 (8): e0237995. Bibcode:2020PLoSO..1537995Z. doi: 10.1371/journal.pone.0237995 . ISSN   1932-6203. PMC   7447056 . PMID   32841267.
  39. ↑ Tarsier Pharma (2022-04-11). "A Phase 3 Randomized, Active-Controlled, Double-Masked Study to Evaluate the Safety and Efficacy of TRS01 Eye Drops in the Treatment of Subjects With Active Non-infectious Anterior Uveitis Including Subjects With Uveitic Glaucoma".{{cite journal}}: Cite journal requires |journal= (help)
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