Sympathetic Uveitis Following Glaucoma Surgery Hanna F. Shammas, MD; Nicholas A. Zubyk, MD; Thomas F. Stanfield, MD

\s=b\ We had two cases of sympathetic uveitis after filtering procedures were performed on blind, painful eyes. A review of the literature shows that it is not the

type of antiglaucoma operation that has to be incriminated in precipitating sympathetic uveitis, but the condition of the eye undergoing a filtering procedure. The risk is much higher when the glaucoma is absolute. There is much danger in operating on blind, painful eyes. (Arch Ophthalmol 95:638-641, 1977) has been

ophthalmia following glauSympatheti c operations known to

occur

since 1900.' It has been mainly described following iridencleisis, corneoscleral trephines, and iridectomies.We recently received at our ophthalmic pathology laboratory an eye that was enucleated because of sympathetic uveitis following a trabeculectomy on a blind, painful eye. A search of our files disclosed another proved case of sympathetic uveitis following a corneoscleral trephine procedure for absolute glaucoma. We would like to report on these two cases of sympathetic uveitis following filtering procedures on eyes with absolute glaucoma and emphasize the risks of any intraocular procedure on blind, painful eyes.

coma

Accepted for publication Oct 23, 1976. From the Department of Ophthalmology, University of Iowa, Iowa City (Drs Shammas and Zubyk). Dr Stanfield is in private practice in Anderson, SC. Reprint requests to Department of Ophthalmology, University Hospitals, Iowa City, IA 52242 (Dr Shammas).

REPORT OF CASES

and the

57-year-old woman had absolute glaucoma in the right eye of three years' duration. The intraocular pressure was 52 mm Hg and could not be controlled with antiglaucoma medications. The left eye was normal with a visual acuity of 20/ Case l.-A

20 and

Hg.

an

intraocular pressure of 14

mm

The patient refused enucleation of the

right

eye. A

trabeculectomy

was

per-

formed on Oct 23, 1975. The procedure was uneventful. Postoperatively, the anterior chamber did not reform and the intraocular pressure remained below 3 mm Hg. Six weeks after the trabeculectomy, the right eye was still injected. The anterior chamber was almost flat and anterior synechiae began to form. The intraocular pressure was more than 50 mm Hg. The left eye was now red and painful. The visual acuity decreased from 20/20 to 20/50. Results of a slit-lamp examination of the left eye showed ciliary injection and 3+ cells in the anterior chamber. A few cells were also seen in the vitreous cavity. The patient was started on an oral regimen of prednisone, 80 mg/day. On repeat examination a few days later, no improvement was noted. The right eye was enucleated. On histopathologic examination of the right globe, the cornea showed areas of bullous epithelial detachment. The pupil was occluded by flbrinous material and the pupillary margins were adherent to the posterior corneal surface. The angle was closed with anterior synechiae (Pig 1). Incarceration of uveal tissue was found at the site of the operation (Pig 2). The choroid was thickened and infiltrated by lymphocytes and epithelioid cells with pigment dispersion and phagocytosis (Pig 3 and 4). The choriocapillaris was spared. This granulomatous reaction was also present in the iris, ciliary body, and along the scierai canals. The ganglion cell layer

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nerve

fiber layer of the retina were

atrophie. The optic nerve head

was

deeply

cupped.

Case 2.-A 75-year-old woman had openangle glaucoma in both eyes since January 1943. She

was

treated with

pilocarpine

hydrochloride and physostigmine (Eserine) drops. On Nov 18, 1943, when she visited her local ophthalmologist, she had a red, painful, blind right eye. The intraoculW pressure was 50 mm Hg as determined by means

of

operation

a

Schiötz tonometer. A trephine performed on the right e.Ve

was

but the surgeon could not perform an iridectomy. Following the operation the right eye remained irritated and painfu»' Eight weeks later the left eye became red and irritated and the patient noted a decrease in the visual acuity of that eyeThe patient was then referred to the University of Iowa for diagnosis and management.

On admission, the right eye was blind' The cornea was edematous, the anteri"1 chamber was absent, and the iris waS adherent to the posterior corneal surfaceThe lens was cataractous and the fundus could not be seen. The intraocular pressure was 60 mm Hg by means of a Schilz tonometer.

Examination of the left eye revealed a circumcorneal Hush, 2+ flare and cells in the anterior chamber, and a moderate nuclear sclerosis. The vitreous was haz.VThe optic disk was slightly edematous and hyperemic. The visual acuity was 20/1" with correction and the intraocular prcS' sure 18 mm by Schiötz tonometer. She was being treated with pilocarpine and phys

Sympathetic uveitis following glaucoma surgery.

Sympathetic Uveitis Following Glaucoma Surgery Hanna F. Shammas, MD; Nicholas A. Zubyk, MD; Thomas F. Stanfield, MD \s=b\ We had two cases of sympath...
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