Circadian Fluctuation Changes in Intraocular Pressure Measured Using a Contact Lens Sensor in Patients with Glaucoma after the Adjunctive Administration of Ripasudil: A Prospective Study.

Nocturnal and circadian intraocular pressure (IOP) fluctuations are important issues in glaucoma treatment. Ripasudil 0.4% eye drops, a new glaucoma medication, lowers IOP by increasing aqueous humor outflow through the trabecular meshwork. We aimed to compare differences between circadian IOP fluctuations measured using a contact lens sensor (CLS) before and after administering 0.4% ripasudil eye drops adjunctively to patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). Patients with POAG (n = 1) and NTG (n = 5) underwent 24 h IOP monitoring with a CLS before and after administering ripasudil eye drops every 12 h (8 a.m., 8 p.m.) for 2 weeks without discontinuing currently used glaucoma medications. No vision-threatening adverse event occurred. The reduction in IOP fluctuation and the reduction in the SD of IOP in 24 h, awake time and sleep time did not reach statistical significance. The baseline office-hour IOP, which was measured using Goldmann applanation tonometry (GAT), ranged in the low teens, and the reduction in office-hour IOP also did not show a significant difference. Further study is necessary to evaluate whether the low baseline IOP with less IOP reduction relates to attenuated IOP fluctuation reduction.

Lacrimal gland pleomorphic adenoma masquerading as thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy is the most common cause of proptosis in adult female, especially those with positive thyroid antibody. Sometimes, other diagnoses should be considered. A 45-year-old female presented with progressive right proptosis and mild diplopia for 2 years. One year earlier, she had been diagnosed with thyroid-associated ophthalmopathy because of abnormal thyroid autoantibody. Computed tomography scan showed a 2.4- × 1.9- × 1.6-mm heterogeneous soft-tissue density lying above the left eye. Excisional biopsy of this mass revealed the histopathologic diagnosis of pleomorphic adenoma. This case highlights the need for including other diagnoses such as pleomorphic adenoma in the differential diagnosis of patients with proptosis, diplopia and abnormal thyroid antibody.