Uveitic Glaucoma Interest Group Recommendations for Uveitis-Related Ocular Hypertension and Glaucoma Management.

Abstract

Purpose: Uveitic glaucoma (UG) is a complex disease with nearly three times higher risk for severe visual loss than uveitis without glaucoma. Monitoring and management vary among ophthalmologists, making it difficult to identify optimal follow-up and treatment approaches. The Uveitic Glaucoma Interest Group (UGIG) proposes guidelines to reduce variation in practice through best practice management guidelines for uveitis-related ocular hypertension (UOHT) and UG.

Methods: A group of ophthalmologists with expertise in uveitis and glaucoma conducted an extensive literature review of UOHT and UG. Following review and discussion generated recommendations to standardize best management practices.

Results: The recommendations cover: 1) glaucoma-related testing and timing, 2) intraocular pressure (IOP) monitoring and goals, 3) follow-up after starting corticosteroids (CS) or IOP-lowering agents, 4) timing of referral to a glaucoma specialist, 5) management considerations and guidelines.

Conclusions: Uveitic eyes have a heightened risk of developing ocular hypertension (OHT) and glaucoma. IOP is often very high and highly variable, associated with rapid progression rates from OHT to glaucoma, and with more rapid visual field loss. Glaucoma can also develop at lower IOP as compared to non-uveitic patients. The UGIG proposes recommendations to standardize the care of UG patients, facilitating more effective management and optimizing visual outcomes. A consensus is presented regarding IOP management based on a more stringent IOP threshold of 16 mmHg. When possible, a close collaboration between a glaucoma specialist and the uveitis expert is preferred. Appropriate referral to glaucoma specialist should be made early, ideally at the time IOP-lowering therapy is initiated.