Outcomes of PI in Uveitic Glaucoma: A Retrospective Study
Uveitis can lead to glaucoma, causing vision impairment. Laser peripheral iridotomy is a common treatment. This study examines outcomes of laser PI in patients with uveitic pupillary block, assessing the need for further interventions to control intraocular pressure. Participant demographics and cumulative failure rates are analyzed in detail.
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Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9thAnnual State Ophthalmological Conference TOSCON 2024 12thto 14thJuly, 2024 at Katriya Hotel & Towers, Hyderabad INTRODUCTION Uveitis is the third leading cause of preventable blindness worldwide Can be complicated by glaucoma, which may follow an aggressive course, with higher IOP and more rapid progression of glaucomatous optic neuropathy Mechanism is often mixed with open angle, closed angle and steroid-induced processes coexisting The formation of synechial adhesion between the uveitic iris and lens can result in seclusio pupillae and iris bombe induces secondary angle closure Peripheral iridotomy (PI) has an established role in the prevention and treatment of this secondary angle-closure mechanism PURPOSE To look at the outcomes of laser PI in patients with uveitic pupillary block
Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad METHODS Retrospective study of 117 eyes that underwent PI using Nd:YAG laser for uveitic pupillary block with iris bombe A subset of patients (29 eyes) underwent laser PI in a phased manner: Sequential Nd:YAG-KTP 532 nm (flattening burns) followed by Nd:YAG 1064 nm (penetrating burns) To minimize bleeding from iridotomy site OUTCOME To assess the need for repeat intervention for control of IOP in the form of repeat PI or surgical PI or glaucoma filtering surgery
Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad RESULTS Participant Demographics N=117 Gender Female 75 Male 42 Uveitis, type GAU 22 NGAU 33 Intermediate uveitis 07 Panuveitis 55 Previous intraocular surgery Yes 16 No 101
Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad RESULTS Participant Demographics N=117 Cumulative failure Gender Female 75 33 (44%) Male 42 11 (26.2%) Uveitis, type GAU 22 06 (27.3%) NGAU 33 14 (42.4%) Intermediate uveitis 07 03 (42.9%) Panuveitis 55 21 (38.2%) Previous intraocular surgery Yes 16 08 (50%) No 101 08 (7.9%)
Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad RESULTS Pre-PI IOP <21 mmHg Pre-PI IOP >21 mmHg Pre-PI IOP >30 mmHg n 33 84 68 Repeat PI 12 17 12 Surgical PI 02 08 6 GFS 01 11 9 Cumulative failure 12 (21%) 32 (21%) 25 (36.8%) Repeat PI Surgical PI GFS Cumulative failure Traditional PI (n = 88) 22 09 09 33 (37.5%) Sequential PI (n = 29) 07 01 03 11 (37.9%)
Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad DISCUSSION Retrospective study of 117 eyes where primary laser PI was performed for uveitic pupillary block Largest such series of laser PI in patients with uveitic pupillary block 10 eyes underwent secondary surgical PI, 12 eyes underwent a glaucoma filtering surgery following the failure of initial laser PI CONCLUSION Predisposing factors for increased risk of failure: Female gender High pre-PI IOP (>30 mmHg) Uveitis type: non-granulomatous anterior uveitis, intermediate uveitis The type of laser PI, traditional or sequential, does not seem to affect the risk of cumulative failure
Manoj Mathur E-Poster OUTCOMES OF PI IN UVEITIC GLAUCOMA Presenting author: Yashas Goyal Co-author: Siddharth Dikshit 9th Annual State Ophthalmological Conference TOSCON 2024 12th to 14th July, 2024 at Katriya Hotel & Towers, Hyderabad REFERENCES 1. Betts TD, Sims JL, Bennett SL, et al. Outcome of peripheral iridotomy in subjects with uveitis. Br J Ophthalmol. 2020;104:8 10 2. Lam DSC, Tham CCY, Congdon NG, Baig N. Peripheral Iridotomy for Angle-Closure Glaucoma. Glaucoma. Elsevier; 2015. pp. 708 715 3. Cruz, M. 2017. III. Laser Surgery in Glaucoma: 19. LASER Iridotomy. In Laser Manual in Ophthalmology Fundamentals and Laser Clinical Practice, ed. J. Henriques, A. Duarte, T. Quint o, 115 - 122
