Clinicians may want to consider topical ocular hypotensive medication washout in uveitic glaucoma patients whose IOP is under control, and especially in the absence of uveitic recurrence, a study in the British Journal of Ophthalmology reports. Since active inflammation and steroid treatment contribute to elevated IOP in uveitis, IOP may revert to normal once inflammation subsides, the team of researchers from the UK suggests.

Culling from prospective clinical trials from 2013 to 2017, the investigation recruited 120 patients who had primary open-angle glaucoma (POAG), ocular hypertension (OHT) or uveitic glaucoma/ocular hypertension.

The study reported the amount of eyes with post-washout IOP less than 22mm Hg was 51.2% in uveitic glaucoma eyes but only 12.7% in the POAG group and 6.1% in OHT eyes.

At the study’s onset, researchers excluded 20 eyes with an IOP of 21mm Hg or less, 11 eyes that had previous incisional surgery and 17 eyes with incomplete data. Additionally, the study excluded uveitic glaucoma eyes on steroid treatment with active inflammation. Participants underwent a one-month washout period from topical ocular hypotensive medications before IOP phasing. Investigators compared pre/post-washout IOP, highest-recorded (peak) and post-washout IOP.

Pre-washout IOP was approximately 18.1±3.3mm Hg in POAG eyes, 18.8±3.3mm Hg in the OHT group and 17.9±8.8mm Hg in uveitic glaucoma patients.

The approximate post-washout IOP was lowest in uveitic glaucoma eyes at 23.1±10.1mm Hg, but higher in the POAG group at 26.6±4.8mm Hg and in OHT eyes at 26.4±3.9mm Hg.

Ho H, Daas A, Ho J, et al. Intraocular pressure changes following topical ocular hypotensive medications washout. Br J Ophthalmol. April 10, 2020. [Epub ahead of print].