Glaukom bei Uveitis im Kindesalter

Abstract

Secondary glaucoma is a common complication in childhood uveitis. The incidence of glaucoma depends on the anatomic localisation of inflammation and the associated underlying disease. The pathophysiology can be divided in secondary angle closure and open angle glaucoma. Data on conservative and operative therapy often rely on small patient groups or can only be transferred from children with non-uveitic glaucoma. The selection of topical medication must reflect the special quality of the juvenile organism. Topical therapy of first choice seems to be antagonists of carboanhydrase due to their good clinical effect without elevated risk profile. As second choice beta-receptor antagonists are suitable. Gel formulations of 0.1% timolol seem to exhibit fewer of the known side effects. Children aged 2 years and under have a special risk of apnoea. Alpha agonists should not be used in children of 6 years and younger because of their central nervous side effects. Prostaglandins might induce more recurrences of uveitis and might aggravate cystoid macular oedema, therefore this group should only be used with restrictions. Active uveitis is a contraindication for the use of prostaglandins. Parasympathomimetics are generally not recommended in uveitis due to the known side effects. Surgical therapy follows ineffective conservative therapy. The choice of the adequate surgical approach depends on individual factors and general recommendations cannot be made. Techniques include filtering procedures, cyclodestructive procedures, trabecular meshwork surgery, and glaucoma drainage devices. Before surgery the duration of quiescence of inflammation should be 8 weeks or longer.