The use of shunts in the treatment of uveitic glaucoma

Dr Lee, Wai Yip Jacky   (Principal Investigator (PI))

Professor Lai Jimmy Shiu Ming   (Co-Investigator)

24

2012-04-01

119600

The use of shunts in the treatment of uveitic glaucoma

Intraocular pressure, shunt, trabeculectomy, Uveitic glaucoma

Vision

201202159010

Seed Fund for PI Research – Basic Research

2011

On-going

Uveitic glaucoma is a form of secondary glaucoma caused by inflammation in the anterior chamber of the eye resulting in elevation of intraocular pressure (IOP). With persistent IOP elevation, the optic nerve becomes irreversibly damaged impairing vision. Glaucoma in uveitis can occur for a number of reasons including: iridocyclitis, trabeculitis, trabecular scarring, steroid response, or later pupil block or angle closure glaucoma from peripheral synechiae (PS) or peripheral anterior syneciae (PAS) formation respectively. The current treatment involves the control of inflammation with steroids (topical, local injections, and even systemic steroids). For IOP control, topical and systemic glaucoma medications may be used. When maximal medication fails to control the IOP, filtration surgery in the form of trabeculectomy or glaucoma drainage device is required to drain the aqueous from the anterior chamber to the subconjunctival space. But such surgeries in uveitic glaucoma is often associated with a high failure rate due to scarring even with the use of anti-metabolites. Traceculectomy in uveitic glaucoma may also be associated with more postop hypotony due to ciliary body shutdown. The EX-PRESS Glaucoma Filtration Device is a metallic implant that can be inserted during standard trabeculectomy and it offers similar IOP reduction to the standard trabeculectomy but offers the following additional benefits that are especially important in uveitic glaucoma: • Does not require a sclerectomy or peripheral iridectomy hence less inflammation and less risk of blockage of the inner windows by fibrin, blood, or iris. • Presence of a flow-modulating design that controls postop aqueous outflow minimzing that risk of hypotony and choroidal effusion. The purpose of this study is to evaluate the efficacy of glaucoma filtration surgery in uveitic glaucoma using the EX-PRESS shunt device.