Secondary glaucoma in CAPN5-associated neovascular inflammatory vitreoretinopathy.

• Type of Material: Article
• Authors: Abdourahman Cham, University of Iowa; Mayank Bansal, All India Institute of Medical Sciences; Himanshu K Banda, Emory University; Young Kwon, Department of Ophthalmology and Visual Sciences; Paul S Tlucek, Department of Ophthalmology and Visual Sciences; Alexander G Bassuk, University of Iowa; Stephen H Tsang, Columbia University; Warren M Sobol, Retina Physicians & Surgeons; James C Folk, Department of Ophthalmology and Visual Sciences; Steven Yeh, Emory University; Vinit B Mahajan, University of Iowa
• Language: English
• Date: 2016-06-27
• Publisher: Dove Medical Press
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Cham et al.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2147/OPTH.S103324
• Title of Journal or Parent Work: Clinical Ophthalmology
• ISSN: 1177-5467
• Volume: 10
• Start Page: 1187
• End Page: 1197
• Grant/Funding Information: VBM was supported by the National Institutes of Health’s grants K08EY020530 and R01EY016822, the Doris Duke Charitable Foundation’s grant 2013103, and Research to Prevent Blindness, New York, NY, USA.
• Keywords: fluocinolone acetonide; ADNIV; calpain-5; CAPN5; secondary glaucoma; uveitis
• Research Categories: Health Sciences, Opthamology; Health Sciences, General

Abstract

OBJECTIVE: The objective of this study was to review the treatment outcomes of patients with secondary glaucoma in cases of autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), a hereditary autoimmune uveitis due to mutations in CAPN5. PATIENTS AND METHODS: A retrospective, observational case series was assembled from ADNIV patients with secondary glaucoma. The main outcome measures were intraocular pressure (IOP), visual acuity, use of antiglaucoma medications, ocular surgeries, and adverse outcomes. Perimetry and optic disk optical coherence tomography (OCT) were also analyzed. RESULTS: Nine eyes of five ADNIV patients with secondary glaucoma were reviewed. Each received a fluocinolone acetonide (FA) implant for the management of posterior uveitis. Following implantation, no eyes developed neovascular glaucoma. Five eyes (in patients 1, 2, and 5) required Ahmed glaucoma valve surgery for the management of steroid-responsive glaucoma. Patient 2 also developed angle closure with iris bombe and underwent laser peripheral iridotomy. Patient 4 had both hypotony and elevated IOP that required periodic antiglaucoma medication in the FA-implanted eye. Patient 3 did not develop steroid-response glaucoma in either eye. Optic disk examinations were obscured by fibrosis and better assessed with OCT. CONCLUSION: ADNIV patients show combined mechanism secondary glaucoma best assessed by OCT of the optic disk. The FA implants have reduced uveitic and neovascular glaucoma. Nevertheless, IOP management remains complex due to steroid-response glaucoma, angle closure glaucoma, and hypotony.