Management of inflammatory glaucomas.

PURPOSE OF REVIEW: To review the epidemiology, pathogenesis and management of uveitic glaucoma in the light of significant studies published during the review period (October 2002-2003). RECENT
FINDINGS: The visual prognosis of glaucoma secondary to certain types of uveitis, for example Juvenile Idopathic Arthritis, remains poor because of late presentation and a high rate of corticosteroid responsiveness. Production of Myocilin is intimately linked with outflow resistance and corticosteroid responsiveness. Although Myocilin gene expression is widespread in the eye, corticosteroid-induction is specific for trabecular meshwork. The hypotensive effect of some glaucoma medications such as Latanoprost and Brimonidine may be partially blocked by concurrent administration of NSAIDs, though the risk of redcrudescence of uveitis with Latanoprost appears to be much lower than initially feared. Use of Mitomycin C in uveitic trabeculectomy has not clearly translated into better long-term IOP control, though this may be due to an absence of prospective studies. Glaucoma drainage devices appear to be more successful in uveitic glaucoma than in other recalcitrant types.
SUMMARY: The management of uveitic glaucoma requires a careful balance between adequate anti-inflammatory therapy and appropriate intraocular pressure (IOP)-lowering to prevent long-term visual loss. In the foreseeable future, successful elucidation of the function of Myocilin is most likely to lead to improvements in the management of corticosteroid-induced and hence uveitic glaucoma.