Uveitic Glaucoma

Post here to exchange iritis general information and support with others.

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hdtrudeau
Posts:3
Joined:Mon Sep 07, 2015 8:48 am
Uveitic Glaucoma

Post by hdtrudeau » Wed Sep 09, 2015 9:05 pm

Hello,

I was wondering about the best type of glaucoma surgery for a young, recurrent iritis sufferer.

I am 39, and have had recurrent iritis x 12 years. It can be in either eye. A "good year" is 1-2 flares. A bad year is 3-4 flares (maybe more??). I've lost count over the years. All of my rheumatologic work ups have been negative. I started having some joint pain and swelling 3 years ago, and was started on plaquenil (working diagnosis of "sero negative inflammatory arthritis"). MTX was added last year, due to continuing have iritis flares. My joint manifestations have been pretty mild.

I've been a steroid responder since the first episode. It doesn't happen every time, and the pressure usually doesn't spike until after I've been on the steroid drops for a bit. Since 2009, my IOP has been persistently elevated in both eyes. I have been on cosopt, alphagan, and diamox since then. Even on those, I can still get pressure spikes into the 30's. When my eyes are clear and I'm off steroids, I can run in the upper teens and low 20's.

My iritis flares have all been anterior, until this year. I had a posterior flare in the left eye in July, then in the right 1 week ago. My right IOP spiked to 48 with the posterior flare. OCT shows I have sustained nerve damage in the right eye now. I have no appreciable vision loss (thankfully!!). My glaucoma specialist says I'm pretty much at the point of surgery, now that I'm showing signs of damage. My previous glaucoma doctor (who left the practice) had thought I should look into a minimally invasive surgery when the time comes, like Trabectome, as the tube/shunt surgery is more likely to fail in a young, chronic iritis patient, and more likely to have hypotony. My new glaucoma doctor says she things tube/shunt is the way to go. I'm getting another opinion.

In the meantime, wondering what has worked best for other iritis patients in my situation. Wondering what the long term prognosis is. Are there uveitic glaucoma specialists out there? I'm in Michigan.

I see my rheumatologist again next week. She said we would add cyclosporine if the MTX/plaquenil wasn't working (which it isn't). She hesitates to start me on Humira d/t having had cancer 2 years ago (which has been resolved).

Thank you!

Mike Bartolatz
Posts:6595
Joined:Fri Feb 06, 2004 9:58 pm

Re: Uveitic Glaucoma

Post by Mike Bartolatz » Tue Dec 08, 2015 3:11 pm

There is a true uveitis specialist/ocular immunologist in Michigan that I can recommend to you. She trained under Dr Foster at Harvard/MERSI.
let me know if you need help. often an Ahmed valve is implanted in uveitis patients.

you may require another drug be added such as Remicade or Humira to the Methotrexate get you to remission and you need an ocular immumologist to do so.

wish you the best,
mike
Mike Bartolatz
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hdtrudeau
Posts:3
Joined:Mon Sep 07, 2015 8:48 am

Re: Uveitic Glaucoma

Post by hdtrudeau » Mon Mar 21, 2016 7:53 pm

yes, I would appreciate getting the name/contact info for that doctor, if you have it.
Heather

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