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Glaucoma and Uveitis

Glaucoma and Uveitis. Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh Consultant, Uveitis Service. Ocular History. 40 year old male OS: defective vision , redness , pain for one week

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Glaucoma and Uveitis

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  1. Glaucomaand Uveitis Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh Consultant, Uveitis Service

  2. Ocular History • 40 yearold male • OS: • defectivevision, redness, painforoneweek • diagnosed with ankylosing spondylitis 7 yearsago

  3. First Presentation • VA:OD 6/9; OS FCF, IOP:OD 15mm Hg; OS 40 mm Hg; • OS: circumcornealcongestion, epithelial edema, non-granulomatousKP's • AC 2+ cells, hypopyon • OD: oldKP's • AC quiet; 270°posterior synechiae

  4. First Presentation - OS

  5. Investigations • Routine baselineinvestigationswithin normal limits • ESR –80mm – 1st hr • Mantoux & TPHA –ve

  6. Diagnosis HLA-B27 typicalanterioruveitis with ankylosing spondylitis with secondary angle closureglaucoma

  7. Treatment • prednisolone e/d (OS) – hourly – 1 week, • followedby gradual tapering • homatropine e/d 3x/day • antiglaucomatous drops e/d (OS) – BID/day • acetazolamide 250mg twice/dayfor 3 days • YAG peripheral iridotomy (OS) after controlofinflammation

  8. Follow up – After 10 days • pain, rednessdecreased • VA: OD 6/6, OS 6/12 • IOP: OU – 20mm Hg • OD: quiet; OS: 1+ cells • prednisolone e/d - taperingtherapy

  9. Follow up – After 6 Months • VA: OU 6/6 • IOP: OD 20 mmgHg; OS 15mm Hg • OS: quiet • OD: • AC 3+ cells; 3+ flare; hypopyon 1mm; posterior synechiae • fundus: noview

  10. Follow up – After 6 Months • OD: • prednisolone e/d (OD) – tapering • homatropine e/d twice/day

  11. Final Presentation – After 8 Months • VA: 6/6 OU • IOP within normal limit • OU: old KPs ; AC -quiet • OS: YAG peripheral iridotomy • Fundus : Normal

  12. Conclusion • acuterecurrencesofanterioruveitisshouldbetreatedaggressively with topicalcorticosteroids • subtenon triamcinolone acetonide ifneeded • carefulwatchforpupillary block glaucoma, then: • timely YAG peripheral iridotomy orsurgicalinventionaremandatory

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