Md Din, NB; (2014) Elevated intraocular pressure in uveitis: effects on the retinal nerve fiber layer, clinical course and surgical outcome in adults and children. Doctoral thesis , UCL (University College London).

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Abstract

Intraocular Pressure (IOP) elevation is a pertinent risk factor for glaucoma in uveitis. Macula oedema and disc swelling may mask glaucoma assessment making glaucoma detection challenging. This thesis aimed to evaluate whether peripapillary retinal nerve fiber layer (RNFL) measurement with the spectral-domain optical coherence tomography (SD-OCT) can be a conjunctive method. We reviewed records of 309 patients with uveitis and analysed the SD-OCT results. Mean RNFL was thicker in uveitic compared to normal eyes. RNFL thinning was seen in all except the temporal quadrant of glaucomatous but only in the inferior quadrant of hypertensive uveitic eyes. RNFL defect was detected in approximately 20% of hypertensive eyes without clinical signs of glaucoma. Older age, higher maximum IOP and uveitis-induced IOP elevation were risk factors for RNFL defect and glaucoma. Reduced RNFL thickness correlated with worsening Humphrey visual field (VF) mean deviation. A chart review of 103 children with non-Juvenile Idiopathic Arthritis-related uveitis revealed IOP elevation occurred in approximately 40% of children, steroid-induced in 35% of eyes with nearly 70% of them being high responders. Chronic uveitis was a strong risk factor for IOP elevation and glaucoma. The RNFL was thicker in uveitic compared to normal eyes. We found no RNFL thinning in hypertensive but significant thinning only in the inferior quadrant of glaucomatous uveitic eyes. The outcome of the second compared to the first eyes of 30 patients with bilateral uveitis and raised IOP who underwent bilateral glaucoma surgery was assessed. We postulated the second eyes would suffer more from oral acetazolamide omission following early phases of surgery. The surgical success rates were comparable with no significant visual acuity progression. Although the survival rate of the cup-to-disc ratio progression was worse in the second eye within the first 5 postoperative years, no significant difference was detected in the Humphrey VF progression.

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