Uveitic Glaucoma

A patient presented to the Bascom Palmer Eye Institute emergency room with complaints of decreased vision, pain, and photophobia in the right eye for 3 months. The patient has no past medical history. He has a past ocular history of prior pars plana vitrectomy and trabeculectomy in the left eye in 2014. He was lost to follow-up for 7 years. On initial presentation, Humphrey visual field (HVF) and ocular nerve and retinal nerve fiber layer (RNFL) imaging identified advanced glaucoma damage in both eyes. The patient was diagnosed with severe uveitic glaucoma in the right eye and was initially treated with corticosteroids and intraocular pressure (IOP) medications. Labs were negative for an infectious or autoimmune condition causing uveitis. He subsequently underwent tube shunt surgery with an Ahmed glaucoma drainage implant in the right eye. Two months later, he underwent gonioscopy-assisted transluminal trabeculotomy (GATT) for persistent intraocular pressure elevation. At the 6-month follow-up clinic visit, his vision is stable, IOP is controlled in the low teens on Combigan twice daily, and his uveitis is stable on topical and systemic corticosteroids. GATT can be effective in reducing IOP and medication burden in patients with uveitic glaucoma. GATT may be an effective procedure for patients with refractory uveitic glaucoma after failed incisional surgery.

Presentation Date: 05/13/2021

Issue Date: 05/21/2021