Purpose: To investigate the clinical features of secondary glaucoma associated with uveitis.
Subjects and methods: The subjects of the study were 1,604 eyes of 1,099 patients with uveitis at Miyata Eye Hospital, Miyakonojo, Miyazaki, between October 1974 and January 2000. The intraocular pressure (IOP) and clinical data were analyzed retrospectively. Secondary glaucoma was defined as being an IOP higher than 21 mmHg and needing treatment with medication to control the high IOP.
Results: Secondary glaucoma was found in 293 eyes (18.3%) of 217 patients (19.7%) among the uveitis patients. The clinical entity with the highest frequency of secondary glaucoma was Posner-Schlossman syndrome in 100%, followed by sarcoidosis in 34.1%, herpetic anterior uveitis in 30.4%, Behçet's disease in 20.8%, HLA-B 27 related acute anterior uveitis in 20.0%, Vogt-Koyanagi-Harada' disease in 16.4%, and HTLV-1 uveitis in 16.2%. Among the 293 eyes with secondary glaucoma, the majority (72%) had active anterior uveitis at the time of high IOP. Only 7.5% of secondary glaucoma eyes had peripheral anterior synechia wider than 180 degrees of trabecular meshwork. Steroid glaucoma was found only in 8.9% of the secondary glaucoma eyes. Surgical therapy mainly with trabeculectomy with anti-metabolites was performed in 38 eyes and the postsurgical IOP was controlled to 20 mmHg or lower in 36 eyes. Despite the medical and surgical therapy for secondary glaucoma, defect of the visual field was found in 38% of the secondary glaucoma eyes.
Conclusions: The frequency of secondary glaucoma in 1,604 eyes with uveitis was 18.3%, and the frequency of secondary glaucoma differed depending upon the clinical entity of uveitis. The evaluation and the management of IOP are very important in treatment patients with uveitis, in addition to the management of intraocular inflammation.