Schwartz-Matsuo syndrome: An important cause of secondary glaucoma.

PURPOSE: We report a case of Schwartz-Matsuo syndrome that highlights the pathophysiology, diagnostic challenges, and management considerations of this rare disease. OBSERVATIONS: 31-year-old man with a history of left eye cataract presented with left eye photophobia and elevated intraocular pressure (IOP) of 64 mm Hg. Visual acuity 20/40. Open angles with an increased pigment of trabecular meshwork by gonioscopy, 2 + anterior chamber (AC) cell, superior retinal detachment, and 0.6 cup-to-disc ratio. Electron microscopy of AC fluid demonstrated outer segments of photoreceptors. IOP was lowered with oral and topical ophthalmic antihypertensives. Retinal detachment was treated with pars plana vitrectomy with endolaser, gas tamponade, and AC paracentesis. Follow-up VA 20/20 with normal IOP. CONCLUSIONS AND IMPORTANCE: Schwartz-Matsuo syndrome is characterized by elevated IOP with marked fluctuations, open angles, aqueous cells, and retinal detachment. Diagnosis is supported by electron microscopy of AC fluid with outer segments of photoreceptors. Treatment includes retinal detachment repair and antihypertensive therapy.

Combined Dexamethasone Intravitreal Implant and Glaucoma Drainage Device Placement for Uveitic Glaucoma.

PRECIS: At 1-year postoperative follow-up, concurrent placement of a dexamethasone intravitreal implant and glaucoma drainage device effectively controlled intraocular pressure (IOP) and inflammation in eyes with uveitic glaucoma with no changes in systemic immunomodulatory therapy. PURPOSE: The purpose of this study was to assess 1-year postoperative outcomes in eyes with uncontrolled uveitic glaucoma following concurrent placement of a dexamethasone intravitreal implant and glaucoma drainage device. MATERIALS AND METHODS: This is a retrospective, observational case series of patients with chronic, noninfectious uveitis and uveitic glaucoma uncontrolled on maximal tolerated medical therapy with at least 1-year postoperative follow-up. The main outcomes were visual acuity, IOP, number of glaucoma medications, recurrent inflammation, frequency of topical steroids, systemic immunomodulatory therapy, and adverse events. Success was defined as IOP <21 mm Hg and IOP reduced by >20% from baseline on at least 2 consecutive visits after 3 months either with or without glaucoma medications (ie, partial or complete success, respectively). RESULTS: Eight eyes in 6 patients met the inclusion criteria. The average age was 44.1±19.7 years (range: 10 to 68 y) and 50% were female. At 1-year, there was no significant change in visual acuity. No eyes lost ≥3 lines of vision. The majority of eyes (87.5%) achieved complete (n=2) or partial success (n=5) with a decrease in average IOP from 36.5 to 11.8 mm Hg (P=0.002). Glaucoma medication use decreased from 3.0 to 1.3 medications (P=0.04). There was a significant decrease in the number of episodes of recurrent inflammation in the 6 months following surgery compared with the 6 months before surgery (P=0.004). CONCLUSION: In this small case series, dexamethasone intravitreal implant combined with Ahmed glaucoma drainage device appears to be an effective approach for the management of uncontrolled uveitic glaucoma.

Central Corneal Thickness Increase Due to Stromal Thickening With Diabetic Peripheral Neuropathy Severity.

PURPOSE: To investigate the relationship between central corneal thickness (CCT) and diabetes disease severity among patients with diabetic peripheral neuropathy (DPN) compared with controls. METHODS: In this cross-sectional study, 34 participants were examined. DPN status was assessed by clinical examination, nerve conduction studies, and quantitative sensory testing. All participants underwent comprehensive eye examination that included intraocular pressure measured by Goldmann applanation tonometry. CCT was measured by ultrasound pachymetry, and the thickness of corneal layers was assessed by corneal confocal microscopy. Association of CCT and DPN was examined using ANOVA. RESULTS: Among the 34 participants, there were 9 controls, 16 patients with mild DPN, and 9 patients with severe DPN. CCT was significantly increased in the DPN groups compared with controls (P = 0.0003). Mean CCT among controls was 552.7 ± 29.2 µm compared with 583.4 ± 25.0 µm in the mild DPN group and 613.3 ± 28.8 µm in the severe DPN group. In addition, stromal thickness differed significantly between the 3 study groups (P = 0.045). Mean stromal thickness among controls was 439.5 ± 23.5 µm compared with 478.9 ± 37.5 µm in the mild DPN group and 494.5 ± 39.1 µm in the severe DPN group. CONCLUSIONS: This study demonstrates that CCT increases with DPN severity because of an increase in stromal thickness. CCT increase associated with DPN has important clinical implications including glaucoma progression, keratoconus susceptibility, and intraocular pressure assessment and should be accounted for when evaluating patients with diabetes.

Advanced pigment dispersion glaucoma secondary to phakic intraocular collamer lens implant.

PURPOSE: We report a case of pigment dispersion glaucoma secondary to uncomplicated phakic intraocular collamer lens (ICL) (Visian ICL™, Staar Inc., Monrovia, CA) implant that resulted in advanced visual field loss. OBSERVATIONS: A 50-year-old man presented for routine follow-up status post bilateral phakic intraocular collamer lens (ICL) placement 8 years earlier. He was incidentally found to have a decline in visual acuity from an anterior subcapsular cataract and elevated intraocular pressure (IOP) in the left eye. There were signs of pigment dispersion and no evidence of angle closure. Diffuse optic nerve thinning was consistent with advanced glaucomatous visual field defects. Pigment dispersion was also present in the patient's right eye, but without elevated IOP or visual field defects. The patient was treated with topical glaucoma medications and the phakic ICL in the left eye was removed concurrently with cataract surgery to prevent further visual field loss. CONCLUSIONS AND IMPORTANCE: Pigment dispersion glaucoma is a serious adverse outcome after phakic ICL implantation and regular post-operative monitoring may prevent advanced visual field loss.

Simultaneous placement of 2 glaucoma drainage devices for uncontrolled glaucoma.

OBJECTIVE: To report baseline characteristics and surgical outcomes of placement of simultaneous glaucoma drainage devices (GDDs) in eyes with considerably elevated intraocular pressure (IOP) despite maximal medical therapy. DESIGN: Retrospective case series. PARTICIPANTS: Twelve eyes of 12 patients underwent simultaneous placement of a Baerveldt 350 GDD and an Ahmed S3 GDD in the same eye. METHODS: The medical records were reviewed of consecutive patients who underwent simultaneous placement of a Baerveldt 350 GDD and an Ahmed S3 GDD in the same eye at the University of Michigan Kellogg Eye Center from 2006 to 2009. Baseline characteristics, preoperative and postoperative IOP, number of glaucoma medications, visual acuity, and complications were recorded. RESULTS: Mean follow-up time was 28.6 ± 22.8 months. The mean baseline cup/disc ratio was recorded at 0.94 ± 0.07 horizontally and 0.92 ± 0.09 vertically. The mean baseline IOP of 38.8 ± 6.2 mm Hg was significantly reduced at all time points postoperatively, and the mean IOP at last follow-up was 15.1 ± 4.9 mm Hg (p ≤ 0.0001). Mean number of glaucoma medications was significantly lower at last follow-up than preoperatively (1.4 ± 1.3 vs 3.2 ± 0.8; p = 0.001). There was no difference in mean logMAR visual acuity from before surgery to last follow-up (1.14 vs 1.12; p = 0.933). CONCLUSIONS: Simultaneous placement of 2 GDDs effectively reduces IOP in the immediate postoperative period and long-term, and may be useful in glaucomatous eyes with advanced disease and considerably elevated preoperative IOP.

Glaucoma screening: current perspectives and future directions.

INTRODUCTION: Glaucoma is an optic neuropathy with characteristic progressive optic nerve degeneration. Early detection and treatment may prevent blindness; however, the value of glaucoma screening has been debated. METHODS: Articles pertaining to glaucoma screening were reviewed. RESULTS: In reviewing the glaucoma literature, there is a lack of a sensitive and specific screening test and concerns over cost-effectiveness. Methods of screening include population-based screening and opportunistic case finding, which both have advantages and disadvantages. CONCLUSIONS: Additional research is needed to better understand glaucoma progression as well as to identify improved screening tests. Consideration must be given not only to the feasibility of performing a glaucoma screening, but also to the follow-up and long-term care for glaucoma patients.