Occurrence and Progression Risk of Uveitic Glaucoma

PURPOSE: This study aimed to determine the prevalence of glaucoma in adult Japanese patients with uveitis and to assess its comorbidity according to the etiology, anatomical classification, and specific disease entities. The relationship between intraocular pressure (IOP) fluctuation and progression of uveitic glaucoma (UG) was also investigated. METHODS: Adult patients (≥20 years at onset) with uveitis treated at Hiroshima University Hospital between July 2009 and June 2023 were included. Data on etiology, anatomical classification, presence of UG, and glaucoma surgery were collected. Disease progression, defined as the slope of the mean deviation (MD) over time, was analyzed in relation to IOP fluctuation (defined as the standard deviation of all IOP measurements/eye). RESULTS: Among 671 patients, 212 (31.6%) had UG and 93.9% had chronic uveitis. Anterior uveitis was the most frequent type (34.4%). Non-infectious causes accounted for 86.3%, with mainly idiopathic (51.4%), sarcoidosis (13.2%), and Vogt-Koyanagi-Harada disease (12.3%). Cytomegalovirus (CMV) anterior uveitis was the most common infectious cause (3.3%). Glaucoma occurred in 33.0% of non-infectious and in 28.1% of infectious cases, and was highest in sarcoidosis (50.0%) and CMV anterior uveitis (77.8%). Glaucoma surgery was required in 41.0% of non-infectious and 60.0% of infectious cases. The MD slope was the most negative in anterior uveitis, and IOP fluctuation was weakly significantly negatively correlated with the MD slope. CONCLUSION: Glaucoma is more common in chronic and anterior uveitis. Sarcoidosis, Vogt-Koyanagi-Harada disease, and CMV anterior uveitis show high comorbidity. Greater IOP fluctuation may correlate with faster visual field deterioration.