Idiopathic intracranial hypertension presenting as iron deficiency anemia: a case report.

BACKGROUND: The presentation of idiopathic intracranial hypertension (IIH) in association with iron deficiency anemia (IDA) is rare. CASE PRESENTATION: This case report depicts the unusual case of a 31-year-old woman of mixed Jamaican and English heritage with IIH who presented initially as IDA in the context of menorrhagia. Subsequent ophthalmic review, lumbar puncture, cerebrospinal fluid analysis and neuroimaging studies revealed severe bilateral optic disc swelling and raised intracranial pressure in keeping with IIH. Prompt treatment of IDA with blood transfusion and orally administered iron supplements, in addition to medical treatment for IIH, contributed to significant improvement of symptoms and prevented long-term visual deficits. CONCLUSION: The possibility of IDA, albeit rare, should always be considered and investigated appropriately in all patients with IIH, as the treatment of the anemia alone may be sight-saving.

Comparative human aqueous dynamics study between black and white subjects with glaucoma.

PURPOSE: To compare the baseline aqueous humor dynamics in white Caucasians and patients of African origin with previously untreated primary open-angle glaucoma (POAG) or ocular hypertension (OHT). METHODS: Ninety-one participants were enrolled in this prospective, observational controlled study: 34 black subjects with POAG or OHT, 32 white Caucasian participants with POAG or OHT, and 12 black and 13 white healthy volunteers as the controls. All aqueous humor parameters were taken between 9 AM and 12 noon on the same day. Intraocular pressure (IOP) was measured by pneumatonometer; morning aqueous humor flow rate was measured by fluorophotometry and trabecular outflow facility by electronic Schiøtz tonography. Uveoscleral outflow was calculated by using Goldmann's equation with assumed episcleral venous pressure of 8, 9, 10, and 11 mm Hg. Differences among groups were analyzed with parametric and nonparametric tests and the relationship between aqueous dynamics parameters were evaluated with linear regression analyses. RESULTS: The POAG/OHT groups had similar IOP (white, 24.6 ± 3.0 mm Hg; black, 24.3 ± 4.0 mm Hg; comparison by Holm's sequential Bonferroni method (HBonf): P(HBonf) = 0.51), outflow facility (white, 0.13 ± 0.09 µL/min/mm Hg; black, 0.13 ± 0.07 µL/min/mm Hg; P(HBonf) = 0.87), aqueous flow (white, 2.36 ± 0.63 µL/min; black, 2.35 ± 0.53 µL/min; P(HBonf) = 0.95), and uveoscleral outflow (white, 0.42 ± 1.59 µL/min; black, 0.58 ± 1.17 µL/min; P(HBonf) = 1.78). POAG/OHT groups had significantly higher IOP and lower outflow facility than their healthy counterparts (P < 0.01). Black participants had significant thinner corneas (540 ± 37 µm vs. 564 ± 36 µm) than those of white participants (P = 0.002). CONCLUSIONS: The aqueous humor dynamics of black African and white Caucasian patients with POAG or OHT have no significant differences. However, the significantly thinner corneas of the black patients may be masking potential differences in outflow facility and IOP measurements between the racial groups.

Effect of primary selective laser trabeculoplasty on tonographic outflow facility: a randomised clinical trial.

PURPOSE: To investigate the effect of 180° versus 360° primary selective laser trabeculoplasty (SLT) on tonographic outflow facility and intraocular pressure (IOP). DESIGN: Prospective, single masked randomised clinical trial. PARTICIPANTS: Patients with untreated primary open angle glaucoma or ocular hypertension both with IOP > 21-35 mmHg. METHODS: 40 patients randomly treated with 180° or 360° SLT after baseline tonographic outflow facility (electronic Schiøtz tonography) and IOP measurements were repeated after 1 month. One eye from each patient was randomly selected for analysis. Eight untreated eyes were included as a control group. MAIN OUTCOME MEASURES: Tonographic outflow facility and IOP difference. Responders were defined as having at least a 20% reduction in IOP. RESULTS: Three patients were excluded due to poor tonography. There were 18 eyes in the 180° group and 19 eyes in the 360° group. Tonographic outflow facility increased significantly (180° p = 0.003, 360° p = 0.005) and IOP decreased significantly (180° and 360° p < 0.001) from baseline. There were no significant differences between the two groups as regards the increase in tonographic outflow facility (180° group 37.5%, 360° group 41%, p = 0.23) and decrease in IOP (180° group 24%, 360° group 35%, p = 0.35). There were similar number of responders in 180° group (72%) as compared to 360° group (89.5%, p = 0.23). Tonographic outflow facility and IOP did not change significantly from baseline in the control group (tonographic outflow facility: 8% increase p = 0.48, IOP: 4% decrease p = 0.33). CONCLUSIONS: Primary SLT significantly increased the tonographic outflow facility and decreased IOP in patients with primary open angle glaucoma and ocular hypertension but no statistically significant differences were found between the 360° and 180° groups. The level of IOP reduction due to primary SLT treatment could not be explained by the increase in tonographic outflow facility alone. Clinical trial registration ISRCTN66330584, Current Controlled Trials. 1/11/2006.