Secondary glaucoma in patients with uveitis

Purpose: To evaluate the prevalence of secondary glaucoma (SG), clinical fo rms of uveitis more frequently associated with glaucoma, and describe the t reatment and complications encountered in a cohort of patients with glaucom a and uveitis during a 10-year period. Methods: The hospital records of pat ients with uveitis referred to the Immunology Service of the Massachusetts Eye and Ear Infirmary for a decade were reviewed for cases of SG. Results: One hundred and twenty of the 1,254 patients (9.6%) with uveitis developed SG. SG was more frequent in anterior uveitis (67%) but was also associated with posterior uveitis (13%) and pars planitis (4%). Herpetic keratouveitis (22%), Fuchs' iridocyclitis (19%), juvenile rheumatoid arthritis-associate d iridocyclitis (16%), syphilis (14%), and sarcoidosis (12%) were the leadi ng types of uveitis associated with SG. Despite aggressive medical and surg ical therapy, SG was associated with progressive visual field loss and opti c nerve damage in 39 patients (33%). Conclusion: SG is an underappreciated, vision-threatening complication in patients with uveitis. Increased vigila nce for emergence of this complicating problem during the care of patients with uveitis is warranted, and medical and surgical treatment for reducing IOP should be especially aggressive in these patients. We hypothesize that earlier, more aggressive treatment of uveitis will reduce the presence of g laucoma as an additional vision-robbing complication of uveitis.