Coexistence of open-angle glaucoma and sarcoidosis-associated optic neuropathy.

BACKGROUND: In cases with advanced glaucomatous disc changes, further changes associated with other optic neuropathies cannot be easily identified. We present a case of preexisting open-angle glaucoma and concurrent involvement of sarcoidosis-associated optic neuropathy. CASE PRESENTATION: A 53-year-old man presented with gradual visual loss in his left eye, which began 1 year ago and accelerated 3 months ago. The best-corrected visual acuity in the right eye was 20/20 and counting fingers in the left. Intraocular pressures (IOP) were 12 mmHg in the right eye and 34 mmHg in the left. We diagnosed him with advanced open-angle glaucoma in the left eye based on the advanced glaucomatous cupping of the left optic disc. The IOP in the left eye dropped to 10 mmHg and was well controlled with antiglaucomatous medication; however, his left optic disc developed pallor 3 months after the treatment. The patient was revealed to be diagnosed with sarcoidosis a month ago and had been treated with systemic corticosteroids thereafter by a pulmonologist. Orbital magnetic resonance imaging revealed sarcoidosis-associated optic neuropathy in the left eye. Subsequently, optic neuropathy occurred in his right eye. CONCLUSIONS: In eyes with advanced glaucomatous disc change, detecting the coexistence of other optic neuropathies can be difficult. This report highlights the importance of careful ophthalmic examinations and investigation for etiologies of other optic neuropathies if non-glaucomatous changes are suspected even in eyes with advanced glaucoma.

The Incidence and Risk Factors of Optic Nerve Damage of Posner-Schlossman Syndrome: A Meta-Analysis.

Objective: To explore the incidence and associated factors of glaucoma optic nerve damage (GOND) among patients with Posner-Schlossman syndrome. Methods: We retrieved relative studies till July 2022 using databases including PubMed, CNKI, VIP, and Wan-Fang. The retrieval terms include "Posner-Schlossman syndrome", "Glaucomatocyclitic Crisis", and "visual field". The Chinese retrieval terms were the corresponding Chinese terminologies for the English terms mentioned above. The outcomes were the incidence of GOND among PSS patients, the male proportion, patient age, the proportion of patients with single eye affected, disease duration, and intraocular pressure during the episode in patients with or without GOND. Review manager 5.3 was used for the analysis. Results: In total, 19 studies were included in our analysis. The pooled incidence of GOND among PSS patients was 0.26 (95% CI = 0.16-0.43). Age [MD = 11.3(5.86, 16.73); P < .0001], disease duration [MD = 4.27 (3.38, 5.16), P < .00001], and single or double eye affected [RR = 0.69 (0.49, 0.98), P = .04] were significantly associated with the development of GOND. Whereas, gender [RR = 1.09 (0.91, 1.29), P = .35] and intraocular pressure at episodes [MD = 2.66 (-0.38, 5.7), P = .09] were not significantly associated with GOND development. Conclusion: A fraction of PSS patients ultimately develop GOND so physicians should not be highly optimistic about the prognosis of PSS patients and timely and effective treatment is very important. Patients of higher age, those with double eyes affected, and suffering from a long disease duration might be at a greater risk of developing GOND.

Retinal vein occlusions associated or complicated with glaucoma. Aspects of prediction and paths of progression.

Background and Objectives: The aim of the study is to evaluate prediction factors and progression paths when retinal vein occlusions are associated with preexisting glaucoma or complicated with neovascular glaucoma. Materials and Methods: The study included 111 patients diagnosed with retinal vein occlusions, of whom 21 with preexisting open angle glaucoma and 12 with neovascular glaucoma as complication. The study was conducted from September 2020 to September 2022 in Timisoara, Romania. We assessed intraocular pressure, cup-disc ratio and retinal nerve fiber layer from the moment of retinal vein occlusion diagnosis until at least one year of follow-up, considering these aspects as values of prediction concerning the paths of progression when glaucoma and retinal vein occlusions come together. Results: The mean initial IOP for the affected eyes was higher (15.89 ± 2.73) than for fellow eyes (15.20 ± 3.11), with an increase of the IOP after one year, but with no statistically significant differences for the affected eyes (p=0.116) or for the other eyes (p=0.684), neither for the affected eyes associated with glaucoma in comparison with affected eyes without glaucoma association. The mean cup-disc ratio was higher for the affected eyes in comparison with the fellow eyes (0.4812 ± 0.219 for the affected eyes and 0.4738 ± 0.229 for the fellow ones in cases without associated glaucoma and 0.681 ± 0.157 for the affected eyes and 0.600 ± 0.241 for the fellow eyes in cases with associated glaucoma), with statistical significant differences in the evolution for both groups in comparison with the unaffected eyes (p=0.0056 for the first group and p=0.0003 for the second group). Comparing the evolution of the affected eyes with the preexisting glaucoma and the affected eyes without preexisting glaucoma, no statistical difference has been found (p=0.1104). The mean retinal nerve fiber layer decreased significantly in affected eyes without glaucoma (from 96 ± 14.71 to 89.16 ± 13.07) and in affected eyes with associated glaucoma (from 78.50 ± 4.23 to 75.50 ± 5.83), but with no significant differences (p=0.182). The level of decreasing was significantly more consistent in association with a venous occlusion (p= 0.0001). Conclusions: The findings of the current study fortify the correlation between glaucoma as a risk factor for retinal venous occlusion development, the intraocular pressure and optic nerve cupping as prediction factors in retinal venous occlusions, the association of a well-controlled preexisting glaucoma with no effect on the progression of the retinal venous occlusions and the development of a neovascular glaucoma with a much aggressive and different path of disease progression.

Thinning of the Lamina Cribrosa and Deep Layer Microvascular Dropout in Patients With Open Angle Glaucoma and High Myopia.

PRCIS: Lamina cribrosa (LC) thinning (thickness of ≤128.00 µm) helps to distinguish open angle glaucoma from high myopia, which was associated with the presence of microvasculature dropout and elevated intraocular pressure. PURPOSE: The purpose of this study was to analyze the factors associated with LC thickness in highly myopic eyes with and without open angle glaucoma. METHODS: In total, 240 highly myopic eyes with γ-zones (194 eyes without and 46 eyes with open angle glaucoma) were examined, and the LC center, externally oblique border, an abrupt change of scleral curvature (scleral step), deep layer microvasculature dropout and global retinal nerve fiber layer thickness were investigated on optical coherence tomography and optical coherence tomography angiography. RESULTS: LC were thinner in highly myopic open angle glaucoma compared with high myopia alone (107.76±9.86 vs. 137.07±18.51 µm, P <0.001), which was associated with deep layer microvasculature dropout and elevated intraocular pressure. The areas under the receiver operating characteristic curve for detecting open angle glaucoma from the LC thickness was 0.964, which was statistically higher ( P <0.05) than from the global retinal nerve fiber layer thickness (0.921) and vertical cup-to-disc ratio (0.902). A LC thickness cutoff value of 128 µm provided 100% sensitivity for detecting open angle glaucoma with 84% specificity. CONCLUSIONS: Highly myopic eyes with open angle glaucoma appear to have a thinner LC, which was associated with elevated intraocular pressure and deep layer microvasculature dropout. LC thinning (≤128.00 µm) helps distinguish open angle glaucoma from high myopia with an abnormal retinal nerve fiber layer thickness distribution and unclear shallow disc cupping.

Visual loss and optic neuropathy in a patient with Klinefelter's syndrome, open-angle glaucoma, vitamin B12 (cobalamin) and folate deficiency.

A 54-year-old man with Klinefelter's syndrome presented to the neuro-ophthalmology clinic with progressive painless visual blurring in the right eye over 2 years. He was receiving intramuscular testosterone therapy for hypogonadism and hypromellose for dry eye. Acuity was reduced bilaterally, and the right optic nerve head appeared pale and asymmetrically cupped. Optical coherence tomography revealed loss of retinal nerve fibre layer thickness in the right eye and visual field testing showed a developing right-ring scotoma. Blood tests showed vitamin B12 and folate deficiencies and polycythaemia. The patient was managed with intramuscular hydroxocobalamin, oral folate administration and re-initiation of his glaucoma medication. In Klinefelter's syndrome, signs of comorbid deficiency can be masked by the polycythaemic effect of testosterone therapy. For patients on long-term testosterone therapy, such as those with Klinefelter's syndrome, we recommend baseline ophthalmic examination and assessment, including intraocular pressure measurement, pachymetry, gonioscopy and screening 24-2 visual field testing.

Local peribulbar anesthesia before glaucoma filtering surgery in a patient with Brugada syndrome.

We report anesthetic management in a patient with Brugada syndrome, an inherited syndrome characterized by normal QT interval, typical ST-segment-elevation in the right precordial leads, and increased risk of sudden cardiac death in the absence of myocardial ischemia or structural heart disease. A 69-year-old man scheduled for glaucoma filtering surgery underwent local peribulbar anesthesia using 5 mL of lidocaine 20 mg/mL solution that was slowly injected into two different sites approximately 10 min prior to the surgical procedure. The surgery proceeded uneventful and data of patient's blood pressure, heart rate, oxygen saturation were collected. Continuous electrocardiography monitoring before, during, and up to 6 h after surgery did not reveal any arrhythmia or tachycardia. A certain number of drugs should be avoided in patients with Brugada syndrome because of their potential risk to trigger an arrhythmia. Among them there are some anesthetics and in particular those that are sodium channel blockers. Ropivacaine and bupivacaine, commonly used for peribulbar block, have been associated with onset of severe arrhythmias. Contrarily, the use of class IB drugs mexiletine and lidocaine is generally considered safe. Local anesthetic agent should be carefully chosen, and anesthesia should be obtained using the minimal necessary drug dose.

Association of Systemic Hypertension With Primary Open-angle Glaucoma: A Population-based Case-Control Study.

PURPOSE: To examine the association between systemic hypertension (HTN) and primary open-angle glaucoma (POAG) using Taiwan's nationwide health insurance claims data. DESIGN: A case-control study. METHODS: Data for this case-control study were retrieved from the Taiwan National Health Insurance Research Database for all 112,929 newly diagnosed patients with POAG from January 2010 through December 2015 (cases), and 449,840 propensity score-matched controls from Taiwan's National Health Insurance system. We performed multiple logistic regression analysis to estimate the odds (ORs) of prior HTN among cases vs controls. RESULTS: Of total 562,300 study patients, 296,975 (52.81%) had HTN prior to the index date, 63,528 (56.49%) among cases and 233,447 (51.90%) among controls (P < .001). POAG was significantly associated with prior HTN (OR 1.31, 95% CI 1.29-1.33) after adjusting for age, sex, monthly income, geographic location and residential urbanization level, hyperlipidemia, diabetes, coronary heart disease, migraine, hypotension, and obstructive sleep apnea syndrome. CONCLUSIONS: POAG is associated with pre-existing HTN, suggesting that internal medicine/family medicine physicians should refer patients with hypertension periodically for regular ophthalmological examinations and ophthalmologists should alert patients with glaucoma to have their blood pressure regularly monitored.

Consultation Section: Glaucoma. Cataract, glaucoma, possible Marfan syndrome, and conception aspirations.

A 36-year-old highly myopic woman was referred for management of both cataract and glaucoma. Her ocular history included retinal detachment repair in each eye, 9 years earlier in the right eye and 7 years earlier in the left eye. Although the patient did not remember specific details of the retinal surgery, she recalled that she had a "gas bubble" postoperatively in the right eye, but not the left eye. She also had a very dense nuclear cataract in the right eye, but only mild nuclear sclerosis in the left eye.At presentation, the patient's corrected distance visual acuity (CDVA) was 20/125 in the right eye, with a large myopic shift (-18.25 + 2.00 × 175). Her CDVA in the left eye was 20/20 (-11.00 + 1.00 × 20). It is notable that she is contact lens-intolerant.Her angle was wide open in each eye, and each optic nerve had severe myopic saucerization and cupping. The axial length was 28.5 mm and 28.7 mm in the right eye and left eye, respectively.The intraocular pressure (IOP) at presentation was 18 mm Hg in the right eye and 20 mm Hg in the left eye; each eye was treated with a topical ß-blocker, α-2 agonist, and a prostaglandin. The highest IOP measurements before treatment were 27 mm Hg and 25 mm Hg in the right eye and left eye, respectively. The pachymetry was 545 µm in the right eye and 540 µm in the left eye.Her visual fields and nerve fiber layers on optical coherence tomography (OCT) are shown in and , respectively.(Figure is included in full-text article.)(Figure is included in full-text article.)Cataract surgery was scheduled along with a coincident glaucoma procedure. It is noteworthy that intraoperatively, the right capsular bag was very loose. Indeed, the capsular bag could not be penetrated with the cystotome, which only dimpled the capsule severely but would not penetrate it. Accordingly, a super-sharp, #15 blade was used to pierce the capsule and initiate the capsulotomy.Whereas the zonule was obviously loose, the remainder of the procedure was completed without incident and the intraocular lens (IOL) placed in the capsular bag with perfect centration. It was unclear whether the loose zonule was a consequence of the patient's vitreoretinal surgery or whether there was a systemic cause for her zonulopathy. Although it was not suspected before the surgery, in retrospect, this patient had the classic body habitus of Marfan syndrome. Moreover, subsequent surgery in the fellow left eye found the zonule to be quite loose, but not as severe as in the right eye.How would you manage this patient's glaucoma? Given the finding of very loose zonular fibers, would you initiate a workup for Marfan syndrome? Certain microinvasive glaucoma surgery (MIGS) procedures are labeled for mild-to-moderate glaucoma. How strictly do you adhere to such labeling? Do you ever use a MIGS device in severe glaucoma?

Dyslipidemia, Dyslipidemia Treatment, and Open-angle Glaucoma in the Korean National Health and Nutrition Examination Survey.

PURPOSE: The purpose of this study was to investigate the association between dyslipidemia treatment and open-angle glaucoma (OAG). PATIENTS AND METHODS: We included 16,939 participants aged ≥40 years from the Korea National Health and Nutrition Examination Survey (2008 to 2012) and classified them into 2 groups based on current dyslipidemia treatment. The prevalence of OAG was determined using the modified International Society of Geographical and Epidemiological Ophthalmology criteria. The association between dyslipidemia treatment and OAG was evaluated using logistic mixed-effects model and propensity-score-weighted odds ratios. RESULTS: Analyses using the 2 abovementioned models revealed that dyslipidemia treatment was not associated with OAG (odds ratio, 1.08; 95% confidence interval, 0.75-1.56; P=0.838 and 1.03; 0.71-1.48; P=0.882, respectively), presence of optic disc hemorrhage (0.64; 0.15-2.73; P=0.648 and 1.10; 0.39-3.11; P=0.855), high vertical cup-to-disc ratio or asymmetry (1.02; 0.81-1.28; P=0.736 and 0.95; 0.75-1.20; P=0.650), presence of retinal nerve fiber layer defects (0.97; 0.67-1.42; P=0.857 and 1.03; 0.75-1.42; P=0.857), and presence of visual field defects (0.93; 0.55-1.54; P=0.931 and 0.97; 0.81-1.52; P=0.528). Total cholesterol and high-density lipoprotein cholesterol were also not associated with OAG. However, higher serum triglyceride levels were associated with OAG in the treated patients (1.31; 1.02-1.68; P=0.027) but not in the untreated patients (1.03; 0.93-1.14; P=0.079). CONCLUSIONS: In the Korean population, dyslipidemia treatment was not significantly associated with open-angle glaucoma. However, hypertriglyceridemia was associated with OAG in treated patients.

Utility of multicolor optic disc photography in evaluation of glaucomatous optic disc in myopic eyes: A novel approach.

Interpretation of optic disc cupping and neuroretinal rim is challenging in myopic eyes because of large, shallow, and tilted disc, myopic crescent, and macular degeneration. Color and red-free optic disc photographs do not reveal the cup/disc ratio often in myopic eyes. We report characteristics of multicolor optic disc photography in three myopic eyes. All eyes underwent multicolor imaging Spectralis SDOCT system (Heidelberg Engineering, Germany). Owing to use of three laser lights in a confocal design, multicolor optic disc photography was able to delineate the neuroretinal rim and optic cup more clearly than color and red-free optic disc photographs.

Pattern noise (PANO): a new automated functional glaucoma test.

PURPOSE: To present a newly developed visual field device (pattern noise: PANO) designed to be sensitive to glaucoma defects, cost-effective, material-practical and easy to repair and therefore particularly suited for low-income countries, where glaucoma can be highly prevalent (e.g. sub-Saharan Africa). METHODS: This is primarily a descriptive paper, but it also includes a prospective matched case-control pilot study. Hardware, stimulus, target configuration, testing strategy and result sheet are described. The main outcome measure is the contrast level (range 2-64). Targets are composed of bright/dark pixels flickering with 18 Hz and have a size of 5°. Pixel size is approximated to the hill of vision. Average luminance of targets is constant and equals background luminance.The study was performed in the West Region in Cameroon. Twenty eyes of 20 newly presenting patients with glaucomatous optic disc cupping on funduscopy were compared with 20 eyes of 20 normal patients matched in age and laterality of eye. RESULTS: Mean age was 32.9 ± 18.8 years for glaucoma patients and 32.2 ± 15.6 years for healthy subjects. Mean contrast threshold was significantly higher in eyes with abnormal disc (16.2 ± 14.3 vs. 4.4 ± 0.8, P = 0.002). Correlation of mean contrast thresholds and cup-to-disc ratio was significant (r = 0.59; P = 0.006). Average examination time was significantly longer for glaucoma eyes compared to healthy eyes (8.2 vs. 6.1 min, P < 0.001), whereas error rate did not differ (4.8 ± 2.5% vs. 4.1 ± 1.8%, P = 0.33). CONCLUSION: PANO demonstrated visual field defects in patients with glaucomatous optic disc. Defects correlated significantly with glaucomatous optic nerve head morphological alterations. Healthy eyes obtained normal results. More studies are needed to establish PANO.

A Unique Case of JOAG With Lamellar Ichthyosis With Rickets: A Case Report and Review of the Literature.

PURPOSE: Ichthyosis is known to have ocular associations such as blepharitis, hypertrophic conjunctivitis, corneal vascularization, ectropion, lagophthalmos, etc. However, no reports of its association with glaucoma are there, to the best of our knowledge. We report a unique case of juvenile open-angle glaucoma (JOAG) with lamellar ichthyosis. METHOD: A 16-year-old male child presented with a gradual, painless progressive diminution of vision in both eyes over a period of 3 years. Systemic examination revealed stunted body growth with knock-knees, suggestive of late-onset rickets. Generalized dry scaly lesions with erythema, along with hyperkeratosis of the palms and the soles, suggestive of lamellar ichthyosis were present. On ocular examination, the intraocular pressure was 36 mm Hg; optic nerve head examination revealed a horizontally oval disc with near total cupping in the right eye and total cupping in the left eye, with extensive neuroretinal rim thinning and pallor. Gonioscopy showed wide open angles with prominent iris processes. Screening of JOAG-associated genes (MYOC, NTF4, WDR36, and CYP1B1) and ichthyosis-associated gene (TGM1) was performed by the direct PCR-sequencing method. RESULTS: A diagnosis of JOAG with advanced glaucomatous optic neuropathy with lamellar ichthyosis and rickets was made. The patient underwent right followed by left eye trabeculectomy with 0.2 mg/dL MMC (for 1 min). Postoperatively, the intraocular pressure was 8 mm Hg at 1 week, and 12 to 14 mm Hg at the 6-week, the 3-month, and the 6-month follow-up, and the visual acuity was maintained in the right eye. No mutations in MYOC, NTF4, WDR36, CYP1B1, and TGM1 were observed in the patient and his family. CONCLUSIONS: An association of glaucoma with ichthyosis should be kept in mind. Therefore, a detailed baseline ocular examination in children with ichthyosis is required, as early detection of glaucoma could prevent irreversible blindness.

Osteogenesis imperfecta and primary open angle glaucoma: genotypic analysis of a new phenotypic association.

PURPOSE: Osteogenesis imperfecta (OI) is a group of inherited disorders characterized by bone fragility. Ocular findings include blue sclera, low ocular rigidity, and thin corneal thickness. However, there are no documented cases linking OI and primary open angle glaucoma (POAG). In this report, we describe three individuals, one isolated case and two from a multiplex family, with OI type I and POAG. METHODS: Available family members with OI and POAG had a complete eye examination, including visual acuity, intraocular pressure (IOP), pachymetry, slit-lamp exam, dilated fundus exam, and visual fields. DNA from blood samples was sequenced and screened for mutations in COL1A1/2 and myocilin (MYOC). RESULTS: All subjects had OI type I. Findings of POAG included elevated IOP, normal gonioscopy, and glaucomatous optic disc cupping and visual field loss. POAG cosegregated with OI in the multiplex family. The multiplex family had a single nucleotide insertion (c.540_541insC) in COL1A1 resulting in a frameshift mutation and a premature termination codon. The sporadic case had a COL1A1 splice acceptor site mutation (c.2452-2A>T or IVS36-2A>T) predicted to result in a premature termination codon due to intron inclusion or a cryptic splice site. None of the glaucoma cases had mutations or sequence changes in MYOC. CONCLUSIONS: We identified two novel mutations in COL1A1 in individuals with OI type I and POAG. Thus, some mutations in COL1A1 may be causative for OI and POAG. Alternatively, susceptibility genes may interact with mutations in COL1A1 to cause POAG.

Analysis of neuroretinal rim distribution and vascular pattern in eyes with presumed large physiological cupping: a comparative study.

BACKGROUND: To investigate possible differences in neuroretinal rim distribution, vascular pattern, and peripapillary region appearance between eyes with presumed large physiological optic disc cupping (pLPC) and eyes with minimal optic disc excavation. METHODS: We prospectively enrolled consecutive subjects with pLPC and individuals with minimal excavation (optic disc excavation within normal limits; control group). All eyes had normal visual fields and untreated intraocular pressure (IOP) <21 mmHg. Eyes with pLPC required vertical cup-to-disc ratio (VCDR) ≥ 0.6 and ≥ 30 months of follow-up with no evidence of glaucomatous neuropathy. For controls, VCDR was limited to ≤ 0.5. We compared ocular signs and characteristics related to the neuroretinal rim distribution, vascular pattern, peripapillary region appearance and disc size between groups. Whenever both eyes were eligible, one was randomly selected for analysis. RESULTS: A total of 74 patients (mean age, 45.6 ± 14.9 years) with pLPC and 45 controls (mean age, 44.8 ± 11.6 years) were enrolled (p = 0.76). Median disc size and VCDR was significantly larger in eyes with pLPC compared to controls (p < 0.01). The proportion of eyes with violation of the ISNT rule, laminar dot sign, nasal shifting of the central vessels, nasal excavation and baring of circumlinear vessel was significantly greater in the eyes with pLPC compared to controls (p < 0.01). There were no significant differences regarding the proportions of eyes with peripapillary atrophy between groups (p < 0.09). Finally, disc size was significantly associated with VCDR (r(2) = 0.47, p < 0.01), with an increase of 0.21 in VCDR for each 1 mm(2) in disc area. CONCLUSION: Compared to normal controls, eyes with pLPC may present a higher proportion of optic nerve head findings frequently observed in glaucomatous eyes. This seems to be explained in part by the larger discs found in these eyes. We believe care should be taken while classifying them as glaucomatous or not based solely on these characteristics.

Baseline prognostic factors predict rapid visual field deterioration in glaucoma.

PURPOSE: To investigate baseline prognostic factors predicting rapid deterioration of the visual field in primary open-angle glaucoma patients. METHODS: Seven hundred sixty-seven eyes of 566 glaucoma patients from the Advanced Glaucoma Intervention Study (AGIS) and the clinical database from Jules Stein Eye Institute's Glaucoma Division were included. The rates of decay at each visual field test location were calculated with pointwise exponential regression analysis (PER), and the rates were separated into faster and slower components for each series. Subjects with a faster component decay rate (≥ 36%/y) were defined as rapid progressors. Sex, race, age, visual acuity, intraocular pressure, mean deviation (MD), number of medications, use of diabetic or hypertension medications, and vertical cup-to-disc ratio at baseline were entered in a multivariable prognostic logistic regression model. RESULTS: The average (± SD) MD was -8.02 (± 6.13), and the average age was 68.64 (± 11.71) years for the study group. Two hundred twenty-two eyes (28.9%) were identified as rapid progressors. The following baseline factors were predictors of faster deterioration: worse MD (P < 0.001, odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.07-1.15), larger vertical cup-to-disc ratio (P = 0.001, OR: 1.23; 95% CI: 1.09-1.39), and older age (P = 0.02, OR: 1.24; 95% CI: 1.04-1.48). After excluding the variables related to glaucoma severity at baseline (baseline MD and baseline vertical cup-to-disc ratio), the likelihood of being a rapid progressor was 54% greater in African Americans than in Caucasians (P = 0.03, OR: 1.55; 95% CI: 1.06-2.27). CONCLUSIONS: Patients with more severe glaucomatous damage, as measured by both visual field or optic disc cupping and older age, are at highest risk for rapid worsening of the disease, as are African Americans compared to Caucasians. More aggressive treatment of such patients should be considered to prevent visual disability.

Progressão atípica de perda visual em paciente com glaucoma primário de ângulo aberto / Atypical progression of visual loss in a patient with primary open-angle glaucoma

A dolicoectasia da artéria carótida interna (ACI) é uma condição rara que pode ser acompanhada de manifestações neuro-oftalmológicas, como perda da acuidade e alteração do campo visual decorrente da compressão do nervo óptico (NO). O objetivo é relatar um caso de paciente do sexo masculino, 67 anos, portador de glaucoma primário de ângulo aberto (GPAA) com evolução atípica, assimetria de escavação, palidez da rima do NO à esquerda, devido à neuropatia óptica compressiva à esquerda, por segmento dolicoectásico da ACI. O diagnóstico foi baseado na história clínica, aspecto do NO e exames de neuroimagem.

Dolichoectasia of the internal carotid artery (ICA) is a rare condition that may be associated with neuro-ophthalmic manifestations, such as loss of visual acuity and visual field resulting from compression of the optic nerve (ON). The aim is to report a 67-year-old male patient with primary open-angle glaucoma (POAG) with atypical evolution, asymmetry of cupping and increased pallor of the rim of the left ON, due to compressive optic neuropathy by the dolichoectatic segment. The diagnosis was based on clinical history, appearance of the ON and neuroimaging.

Isolated traumatic aniridia after trabeculectomy in a pseudophakic eye.

This is a single case report of an elderly patient who had blunt trauma in an eye that had phacoemulsification and two trabeculectomies. She had good vision with a well-functioning bleb before the trauma. She presented during her routine follow-up visit for glaucoma with isolated aniridia and an intact globe. The capsular bag, zonules, and the intraocular lens were intact. The cupping was 0.8, and the rest of the fundus and macula were normal. Pigments were seen over the sclera extending posteriorly upto the fornix. Gonioscopy revealed only faint pigments at the fistula. Following the trauma, the intraocular pressure had increased to 26 mm Hg. The mechanism and the management of the glaucoma are discussed.