Consultant, Uveitis Service Glaucoma and Uveitis Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh 1

Ocular History 40 year old male OS: defective vision, redness, pain for one week diagnosed with ankylosing spondylitis 7 years ago 2

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First Presentation VA:OD 6/9; OS FCF, IOP: OD 15mm Hg; OS 40 mm Hg; OS: circumcorneal congestion, epithelial edema, non-granulomatous KP's AC 2+ cells, hypopyon OD: old KP's AC quiet; 270° posterior synechiae 4

First Presentation - OS 5

Investigations Routine baseline investigations within normal limits ESR –80mm – 1st hr Mantoux & TPHA –ve HLA-B27 positive? 6

Diagnosis HLA-B27 typical anterior uveitis with ankylosing spondylitis with secondary angle closure glaucoma 7

Treatment prednisolone e/d (OS) – hourly – 1 week, followed by gradual tapering homatropine e/d 3x/day antiglaucomatous drops e/d (OS) – BID/day acetazolamide 250mg twice/day for 3 days YAG peripheral iridotomy (OS) after control of inflammation Triamcinolone subconjunctival or intravitreal? 8

Follow up – After 10 days pain, redness decreased VA: OD 6/6, OS 6/12 IOP: OU – 20mm Hg OD: quiet; OS: 1+ cells prednisolone e/d - tapering therapy 9

Follow up – After 6 Months VA: OU 6/6 IOP: OD 20 mmg Hg; OS 15mm Hg OS: quiet OD: AC 3+ cells; 3+ flare; hypopyon 1mm; posterior synechiae fundus: no view 10

Follow up – After 6 Months OD: prednisolone e/d (OD) – tapering homatropine e/d twice/day 11

Final Presentation – After 8 Months VA: 6/6 OU IOP within normal limit OU: old KPs ; AC -quiet OS: YAG peripheral iridotomy Fundus : Normal Do you have a final VU and a time point of last visit? 12

Conclusion acute recurrences of anterior uveitis should be treated aggressively with topical corticosteroids subtenon triamcinolone acetonide if needed careful watch for pupillary block glaucoma, then: timely YAG peripheral iridotomy or surgical invention are mandatory Sc or intravitreal? 13