Uveitic glaucoma poses special challenges for the internist, rheumatologist, uveitis specialist, glaucoma specialist and the patient. Exuberant inflammation, severe conjunctival scarring, iris neovascularization, corticosteroid-induced cataracts, medication side effects and the increased risk of hypotony make uveitic glaucoma especially difficult to manage. Careful preoperative evaluation insures that the correct diagnosis is made and an appropriate treatment plan is implemented. It is imperative that pre-and postoperative intraocular inflammation be controlled adequately with judicious medication use. When conservative measures fail, glaucoma drainage devices can provide an effective means of lowering intraocular pressure. Although several different, effective drainage implants are available, we prefer to use the modified 250 mm2 BGDD for the majority of our uveitic patients with elevated IOP. Innovations in implantation technique and glaucoma drainage device modifications have improved our ability to achieve and maintain a low IOP in these challenging uveitic eyes. Careful preoperative planning and meticulous attention to operative technique can minimize complications and enhance surgical safety and efficacy.
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