Etiopathogenesis and contemporary aspects of inflammatory glaucoma

Abstract

Background: Inflammatory (also known as uveitic) glaucoma is a secondary glaucoma and one of the most serious complications of intraocular inflammation. It is expressed by permanent or periodic increase in IOP with anatomical and pathophysiological changes characteristic for openangle glaucoma. It is one of the leading causes of irreversible loss of vision worldwide, although it is a quite rare disease. According to estimates, 2 mln. of people are suffering from uveitis worldwide, about 20% of them develop secondary glaucoma, without any predilection of race, sex or age. Secondary glaucoma is a serious condition in patients with uveitis caused by systemic diseases, the consequences of which lead to a drastic decrease in visual acuity and invalidation of young patients. It constitutes 24-40% in the structure of glaucomatous pathology. In patients with chronic uveitis, the incidence of secondary glaucoma after 5 years of disease is 11%, and in those with recurrent acute uveitis, the incidence of secondary glaucoma after 1 year of disease is 7.6%. According to Merayo-Lloves J. et al., who conducted a study on 1254 patients with uveitis, secondary glaucoma developed in 120 of them (9.6%). It was more common in those with anterior uveitis (67%), but was also associated with posterior uveitis (13%) and pars planita (4%). Among the main causes of uveitis were herpetic keratouveitis (22%), Fuchs iridocyclitis (19%), iridocyclitis associated with juvenile rheumatoid arthritis (16%), syphilis (14%) and sarcoidosis (12%). Despite aggressive drug and surgical treatment, secondary glaucoma was associated with progressive loss of visual field and optic nerve damage in 39 patients (33%). Discussions: We are currently studying the action of anti-VEGF drugs in the treatment of inflammatory glaucoma, but more studies are needed to confirm its effectiveness. In addition to this treatment, patients undergo antiglaucoma medication and surgery as needed.