Retinal disease and glaucoma can be overlapping conditions which present opportunities for collaboration among subspecialties.
Anita Agarwal, MD, discussed diagnostic and management considerations for patients with hypertensive uveitis, central retinal vein occlusion (CRVO), narrow angles, and retinal dystrophy, and the need for pars plana tube shunt surgery. She outlined these opportunities at the 23rd annual Glaucoma Symposium, held during the 2019 Glaucoma 360 meeting.
Elevated intraocular pressure (IOP) is a feature of certain types of uveitis.
Reminding glaucoma specialists to conduct a thorough examination to establish an accurate diagnosis that will guide appropriate treatment, Dr. Agarwal underscored her point with several case presentations.
One case involved a HIV-positive patient who presented with elevated IOP and anterior uveitis.
“Cytomegalovirus was suspected to be the cause of the uveitis because the patient was HIV-positive, but the posterior segment examination showed widespread Toxo-plasma retinitis,” said Dr. Agarwal, West Coast Retina Group, San Francisco, and adjoint professor of ophthalmology, Vanderbilt University, Nashville, TN. “This patient needed treatment for the ocular inflammation and elevated IOP, but also needed systemic treatment for the toxoplasmosis.”
Another case involved a female patient presenting with hypertensive anterior uveitis in the left eye due to herpes zoster, based on the presence of vesicular cutaneous lesions over a V1 distribution.
The patient was treated with topical corticosteroids, pressure-lowering medication, and oral acyclovir, which she was taking infrequently. She returned after two weeks complaining of blurred vision in the right eye.
On exam-nation, the right eye was found to have keratitic precipitates, 2+ anterior chamber cells, significant vitritis, and acute retinal necrosis. “In patients with anterior uveitis, it is important to think about the potential for involvement of the posterior segment and also the fellow eye,” Dr. Agarwal said.
To prevent complications that can cause permanent vision loss, treatment for patients with hypertensive uveitis requires aggressive intervention to control both the inflammation and elevated IOP. Corticosteroid therapy remains the mainstay for suppressing inflammation, and in certain chronic situations, such as sarcoidosis, it has been revolutionized by the availability of long-acting intraocular implants, Dr. Agarwal said.
“Treat the inflammation fully and don’t worry about an IOP-steroid response,” Dr. Agarwal said. “If using a steroid implant, advise patients that they have a 100% chance of developing a cataract and persistently elevated IOP that may require cataract surgery and a glaucoma tube shunt.”
Retinal disease and glaucoma can be overlapping conditions which present opportu-nities for collaboration among subspecialties.