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Inside this issue: Issue 1 2019


Special Focus:  Glaucoma in the setting of inflammatory diseases

Author: Bahram Bodaghi MD, PhD

Department of Ophthalmology, Sorbonne University, DHU ViewRestore, Pitié-Salpêtrière Hospital, Paris, France

Core Concepts

  • Glaucoma is one of the worst sight-threatening complications of ocular inflammatory diseases.
  • Most etiologies are infectious with a high prevalence of classical or viral disorders.
  • Clear diagnosis requires detailed clinical examination.
  • Optimal management requires both uveitis and glaucoma expertise

What’s New: Principles of medical and non-medical management of glaucoma in dry eye patients                                           

Author: Christophe Baudouin, MD,PhD

Quinze-Vingts National Ophthalmology Hospital, and Vision Institute, Paris, France

Core Concepts

  • The ocular surface is frequently damaged in glaucoma patients on long term topical medical treatment.
  • Active compound, preservative and individual patient sensitivities may interact to cause or aggravate ocular surface disease (OSD).
  • The preservative benzalkonium chloride (BAK) may play an important role in dry eye through its own chemical properties.
  • The number of BAK-containing eye drops instilled each day is a significant risk factor for failure in glaucoma surgery. 
  • In patients with OSD it is advisable to use preservative-free or at least BAK-free eye drops
  • Removal of the causative compound(s) is more effective than adding eye drops to counteract OSD (subtractive preferred to additive strategy).

Clinical Issues: Paediatric Uveitic Glaucoma 

Author: Sophia L Zagora MD FRANZCO1,2,3, John Grigg MD FRANZCO1,2,3

1 Discipline of Ophthalmology, University of Sydney, Sydney Australia

2 Sydney Eye Hospital, Sydney Australia

3 Children’s Hospital Westmead, Sydney Australia

Core Concepts 

  • Paediatric uveitis is rare, 5-10% of the uveitis burden.
  • Although many cases are idiopathic, 41–67% of uveitis in children is linked with Juvenile Idiopathic Arthritis (JIA) and 3–6% with Sarcoidosis.
  • Systemic management of the intraocular inflammation is crucial to reduce the vision threatening complications of paediatric uveitic glaucoma.
  • While screening guidelines remain the same the 2018 EULAR guidelines and the Sycamore trial highlight multidisciplinary care and use of biologics to control disease to reduce the incidence of secondary uveitic glaucoma.

Practical Tips: Glaucoma and concomitant eye diseases

Author: Stephanie Watson Bsc(Med), MBBS, PhD, FRANZCO

Sydney Medical School Foundation Fellow The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia

Core Concepts

  • In ocular surface disease such as Sjogren’s syndrome the treatment of glaucoma can further compromise a patients’ quality of life.
  • To improve outcomes for your patient with ocular surface disease and glaucoma, avoid preservatives in and reduce the number of topical medications.
  • Ocular inflammation and/or it’s treatment with steroids, can increase intraocular pressure leading to glaucoma.
  • Patient’s with Posner Schlossman syndrome, suffer with recurrent attacks of increased intraocular pressure and inflammation, long-term monitoring is needed due to the risk of glaucoma.
  • In Fuch’s corneal dystrophy eventual failure of the corneal endothelium is most commonly managed with an endothelial keratoplasty. This procedure can be performed in patients with glaucoma, including those with drainage devices, but in the long-term re-grafting maybe needed