Efficacy of early aqueous suppression after glaucoma drainage device surgery in uveitis patients

Surgical implantation of a glaucoma drainage device (GDD) is one of the most common incisional glaucoma surgical procedures performed in the US. Although GDD is effective in reducing intraocular pressures (IOP), a hypertensive phase (HP) commonly occurs 2-6 weeks after surgery due to inflammation and excessive fibrosis around the GDD endplate. Patients who experience a HP have increased IOP, need more medication and additional surgeries months after, and have an increased risk of optic nerve damage. To prevent this, studies have shown that early administration of aqueous suppressant medication leads to reduced HP frequency in patients who have undergone GDD implantation. This new practice has dramatically improved outcomes in patients undergoing GDD implantation and is now widely adopted by glaucoma specialists. While administration of early aqueous suppressants has been shown to reduce the risk of glaucoma damage through reduction of HP frequency post-GDD, there has been limited research published focusing on the effects of early aqueous suppression in uveitic glaucoma patients. Although uveitic inflammation may lead to IOP elevation due to obstruction of the trabecular meshwork outflow pathway, inflammation of the ciliary body may also result in aqueous hyposecretion. Thus, uveitic glaucoma patients are at reported increased risk of hypotony (IOP ≤5 mmHg). Hypotony can lead to a host of harmful ocular effects, including visual impairment. A study by Daniel et al. found that 84.1% of uveitic eyes with hypotony had a visual acuity of 20/200 or worse. Hypotony is also associated with accelerated cataract development, retinal detachment, and hypotony maculopathy, which includes optic nerve edema, vascular tortuosity, choroidal folds, and macula striae that lead to vision loss. Several studies have demonstrated the increased risk of hypotony in uveitic patients, the associated significant ocular damage that follows, and the occurrence of these adverse events in uv