Reducing Uveitic Glaucoma: therapeutic judgement is the key

Background: Uveitic glaucoma (UG) due to disease and /or therapeutics is an important reason for reduced vision. Different therapeutic regimen employed in uveitis can alter the course of UG. Purpose: Evaluation of prevalence of UG with different commonly used therapy. Study design: Randomised prospective hospital based study Study Period: 2007-2012 Methods: Baseline IOP; Field and optic nerve head photographs were recorded. Three groups were randomised: 1.topical steroid 2.Systemic steroid +gr 1, 3.Topical synthetic steroids, cycloplegic and periorbital triamcinolone injection. Outcome measure: IOP more than 22 mm/4 mm increase from baseline is marker. Results: 1254 cases of uveitis with 82 cases of uveitic glaucoma were included .Prevalence:63 per100000, 70% in anterior uveitis. During treatment, UG was maximum (80%) in first group and least (5%) with synthetic steroid combined with periorbital triamcinolone. Multi variate analysis shows synthetic steroid and periorbital triamcinolone has least association with UG. Macular oedema was more in UG which improved with low dose acetazolamide.25% cases had progressive visual field loss. Conclusion: UG is an underappreciated visual threat in uveitis which can be modulated effectively with newer steroids and low dose acetazolamide.