Early onset and rapid progression of glaucoma in a neonate with Sturge-Weber syndrome.

Sturge-Weber syndrome (SWS) is an uncommon neurocutaneous syndrome usually presenting with a triad of cutaneous, neurological, and ophthalmological symptoms. The cutaneous lesion can be observed at birth in most cases while the symptoms of the nervous and ocular systems involvement usually appear later in life. The most common ocular manifestation in SWS is glaucoma, which can occur in the early-life period. The authors reported a case of SWS in which the symptoms of glaucoma rapidly developed within two weeks following an ophthalmologic evaluation that was initially negative at the age of one week.

Surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients.

PURPOSE: To compare the surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients. DESIGN: Retrospective comparative case series. METHODS: This was a comparative case series of 36 eyes of 36 African Americans and 43 eyes of 43 whites that underwent placement of the Ex-PRESS glaucoma filtration device under a partial-thickness scleral flap for uncontrolled glaucoma. All eyes received intraoperative mitomycin C. The primary outcome measures were intraocular pressure (IOP), number of postoperative glaucoma medications, and surgical success. Surgical success was defined as IOP between 5 and 18 mm Hg, with or without glaucoma medications, without further glaucoma surgery, or loss of light perception vision. RESULTS: Average follow-up was 31.9 ± 9.8 (range, 14.6-47) months for African Americans and 30.7 ± 8.6 (range, 14.3-47) months for whites. At 33 months, surgical success was 80.0% in the African American group and 83.3% in the white group (P = 1.00). Reasons for surgical failure included increased IOP (3 eyes, 3.8%), persistent hypotony with maculopathy (1 eye, 1.3%), and further surgery (4 eyes, 5.06%). Compared with preoperative values, the mean postoperative IOP and number of glaucoma medications were significantly reduced in both groups, and no statistical difference was observed between the two groups at 33 months. Postoperative complications were similar in the two groups. CONCLUSIONS: Similar surgical outcomes were observed in African American and white glaucoma patients after implantation of the Ex-PRESS glaucoma filtration device. This latest modification of glaucoma filtration surgery may be a better surgical option for African Americans given its potential advantages of no tissue removal, predictable outcomes related to consistent lumen size and controlled flow, fewer postoperative complications, and overall reduced inflammation.

Drug-induced secondary glaucoma.

Several classes of drugs have potential to cause an elevation of IOP which may occur either by an open-angle mechanism or a close-angle mechanism. Drug-induced elevation of IOP is commonly has an open-angle mechanism. The most commonly recognized medications associated with this mechanism are the corticosteroids. Acute angle closure glaucoma is a potentially blinding side effect of local and systemic drugs, including antipsychotic drugs, antidepressants, monoamine oxidase inhibitors, antihistamines, antiparkinsonian agents, antispasmolytic drugs, mydriatic agents, the sympathetic agents and botulinum toxin, especially in individuals with predisposing narrow angles of the anterior chamber. Sulfamate derivative medications may induce angle closure by a different angle closure mechanism, involving anterior rotation of the ciliary body. Clinicians should be mindful of the possible drug-induced glaucoma, whether or not it is listed as a contraindication and, if in doubt, ophthalmological consultation is recommended.

Comparative study of two central corneal thickness measurements in glaucoma patients.

BACKGROUND: Goldmann applanation tonometry (GAT) has been the gold standard for IOP measurements in glaucoma patients. The accuracy of GAT measurements is dependent on many factors, particularly the central corneal thickness (CCT) has been shown to have effect on IOP measurements. OBJECTIVE: To compare of two central corneal thickness measurements in glaucoma patients. MATERIAL AND METHOD: Forty-five right eyes of 45 patients were enrolled. All patients underwent a complete ophthalmologic examination. CCT measurements were performed with an ultrasound pachymeter on two different visits. Patients presenting Diabetes Mellitus (DM), previous history of intraocular surgery and laser were excluded. Antiglaucoma medications were allowed to use during the study. For statistical analysis, paired t-test was used. RESULTS: In the present study, the mean age of patients was 59.18 years. (range 40-91 years). Twenty-one patients (46.7%) were male and twenty-four patiens (53.3%) were female. The interval between two measurement periods was 8.42 weeks (range 2-24 weeks). The mean CCT values were not significantly different between the two visit (521.29 micron SD 32.52 micron and 518.76 micron SD 33.26 micron; p = 0.15). CONCLUSION: In the present study which excluded patients with DM, previous history of intraocular surgery and laser treatment was shown that there was no statistically significant difference in CCT measurements on different occasions.

Bilateral acute onset myopia and angle closure glaucoma after oral topiramate: a case report.

OBJECTIVE: Describe bilateral acute onset myopia and angle-closure glaucoma as ocular adverse effects of topiramate. CASE REPORT: A 23 year-old woman developed bilateral severe blurred vision seven days after initiating therapy with topiramate. Her visual acuity was counting fingers in both eyes. Intraocular pressures were 33 mmHg and 32 mmHg in the right and left eyes, respectively, with conjunctival chemosis, corneal edema, shallow anterior chambers, and closed angles. Her refraction was -7.50 diopters in both eyes. The symptoms and clinical findings resolved completely upon discontinuation of topiramate and, administration of antiglaucoma drugs. CONCLUSION: Topiramate use can result in acute bilateral angle-closure glaucoma and myopia, which are usually reversible upon cessation of the drug. Visual outcome is usually good and the episode resolves within a few weeks. Thus, it is important for clinicians to recognize these conditions and educate patients about these serious adverse effects when prescribing topiramate.