RNFL scans may have limited value for monitoring glaucoma in uveitic eyes

This retrospective pilot study found that uveitis is a major confounding factor in assessing the thickness of the retinal nerve fiber layer (RNFL), suggesting that RNFL scans may not be able to accurately detect and monitor glaucoma in uveitic eyes. Specifically, the researchers found RNFL thickening in patients with active uveitis and greater RNFL thickness than anticipated in those with uveitic glaucoma,

They evaluated OCT RNFL measurements in patients with active and inactive uveitis with or without glaucoma and compared the results to published data on age-adjusted normative patients. They included 76 uveitic eyes without glaucoma and 135 uveitic eyes with glaucoma.

Global and sectoral RNFL measurements were greater in patients with nonglaucomatous uveitis with active inflammation compared to normal patients. The mean global RNFL measurement was 140.5 microns in patients with active uveitis compared with 107.8 microns in nonglaucomatous quiescent patients with uveitis, which was significantly different. The measurements in both groups were significantly higher than the average 95.3 microns reported in normal eyes (P < 0.001).

They conclude that normal mean RFNL thickness in patients with uveitis and glaucoma appears to be higher than in patients with glaucoma without uveitis. It appears that inflammation leads to thickening of the nerve fiber layer, which may complicate the clinical management of patients with uveitis and glaucoma.