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

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

3. 3

4. 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

5. First Presentation - OS5

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

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

8. 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

9. 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

10. 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

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

12. 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

13. 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