A peculiar case of aqueous misdirection from a pseudophakic secluded pupil in a patient with chronic angle closure glaucoma.

Purpose: To explore the course of a pseudophakic and pseudoiridic 61-year-old man with a history of open angle glaucoma in his right eye who developed a sub-totally secluded pupil then later presented with angle closure, a significant pressure spike, and a marked myopic refractive shift, consistent with aqueous misdirection. Observations: Goniosynechialysis, surgical removal of much of the native peripheral iris, and zonulohyaloidectomy led to a return to his prior refraction and improve intraocular pressure (IOP) control. Conclusions and Importance: This case demonstrates that a diagnosis of aqueous misdirection should not be disregarded in the presence of a prior vitrectomy and that aqueous misdirection should be strongly considered in cases of elevated IOP with a patent peripheral iridotomy, myopic shift and angle narrowing.

Comparison of Glaucoma Drainage Device Versus Transscleral Cyclophotocoagulation for Secondary Glaucoma Following Ocular Surface Stem Cell Transplantation.

PRCIS: Rates of ocular surface failure and glaucoma reoperation were similar between cyclophotocoagulation (CPC) and glaucoma drainage devices (GDDs). CPC is a safe option in the management of secondary glaucoma after ocular surface stem cell transplantation (OSST). PURPOSE: To assess surgical and ocular surface outcomes in patients requiring glaucoma surgery after OSST. MATERIALS AND METHODS: Retrospective chart review of eyes with previous OSST that underwent either transscleral CPC or implantation of a GDD. Primary outcomes were ocular surface failure (defined as recurrence of corneal conjunctivalization with late fluorescein staining) and glaucoma surgery failure (defined as the need for additional glaucoma surgery, including repeat treatment or revision). Secondary outcomes were changes in intraocular pressure (IOP) and number of glaucoma medications. Additional subgroup analysis was performed for subtypes of CPC and GDD. RESULTS: Thirty-six glaucoma surgeries (7 Ahmed, 19 Baerveldt, and 10 CPC) were performed in 31 eyes with a history of prior OSST. The ocular surface failure rate was 19% for GDDs and 10% for CPC (P=0.65). Additional glaucoma surgery was needed for 38% of GDDs and 70% of CPC (P=0.14). The mean IOP reduction was 50% for GDDs and 28% for CPC (P=0.05). The mean drop reduction was 1.6 for GDDs and 0.1 for CPC (P=0.02). All glaucoma failures in the GDD group were related to tube erosion and/or hypotony, whereas all glaucoma failures in the CPC group were because of uncontrolled IOP. There were no significant differences in primary or secondary outcomes between CPC or GDD subgroups. CONCLUSION: Glaucoma is a frequent comorbidity in patients with severe ocular surface disease, and treatment poses unique challenges in those with prior OSST. In this study, ocular surface failure and glaucoma reoperation rates were similar between CPC and GDD groups, suggesting that CPC, including repeat treatment, is a safe option for the management of secondary glaucoma after OSST. A multidisciplinary approach is recommended in the management of these complex eyes.

Transient expression of Wnt5a elicits ocular features of pseudoexfoliation syndrome in mice.

PURPOSE: Pseudoexfoliation (PEX) syndrome is an age-related systemic disease with ocular manifestations. The development of animal models is critical in order to elucidate the cause of the disease and to test potential treatment regimens. The purpose of this study is to report phenotypes found in mouse eyes injected with Adenovirus coding Wnt5a. Some of the phenotypes resemble those found in PEX patients while others are different. METHODS: Recombinant Adenovirus coding Wnt5a or green fluorescent protein (GFP) were injected into mouse eyes. Two months after the injection, eyes were examined for PEX phenotypes using slit lamp, fluorescence stereomicroscope, histological staining, immunostaining and transmission electron microscope. RESULT: Certain ocular features of PEX syndrome were found in mouse eyes injected with recombinant Adenovirus coding Wnt5a. These features include accumulation of exfoliation-like extracellular material on surfaces of anterior segment structures and its dispersion in the anterior chamber, saw-tooth appearance and disrupted basement membrane of the posterior iris pigment epithelium, iris stromal atrophy and disorganized ciliary zonules. Ultrastructure analysis of the exfoliation material revealed that the microfibril structure found in this model was different from those of PEX patients. CONCLUSION: These features, resembling signs of ocular PEX syndrome in patients, suggest that new information obtained from this study will be helpful for developing better mouse models for PEX syndrome.