Glaucoma surgery and laser treatment in uveitis are performed when medical therapy fails to place intraocular pressure within the normal range.
It is also performed in some cases of iritis, or anterior uveitis, when the presence of synechiae threatens to narrow, or close, the drainage angle.
Please note: It’s helpful to have read the medical treatment of glaucoma first before reading the rest of this article.
Some patients will already have changes to their optic nerve, which indicate damage to the optic nerve fibres has occurred. Many medical papers make reference to the need for ‘quiet eyes,’ that is, that inflammation must be under control before surgery and for this control to be maintained post operatively.
Current research is investigating the different types of inflammatory cells present in the aqueous humor and on the ocular surface in uveitis. This research may be helpful in identifying those patients for whom trabeculectomy is likely to be very successful.
For some types of uveitis, the early control of inflammation is essential in order to reduce the likelihood of intraocular pressure rising, secondary to disease, and to help avoid the need for glaucoma surgery.
Numerous medical papers report different outcomes for the success of glaucoma interventions between eyes that have had previous surgery, such as cataract surgery, and those that have not. Furthermore, for some procedures, the use of glaucoma drops before surgery may affect the success of surgery.
It is most unlikely that you will be considered for glaucoma surgery or laser treatment without very good reason; and it is almost certain that your doctor has chosen the best intervention for your type of uveitis.
Your reading here should reassure you about the need for a particular procedure and how the procedure should reduce, or perhaps even eliminate your current need for multiple glaucoma drops, as well as safe guarding your sight from loss of visual field in the future.
It is advisable that any procedure is carried out by a glaucoma specialist who works alongside a uveitis specialist, or who is taking advice from one. If you also have a cataract, the two surgeries are sometimes combined.