Romanian Neurosurgery (Sep 2010)
Combined mechanism glaucoma asociated with Grave's Ophtalmopathy
Abstract
A 69-year-old female presented marked vision loss in both eyes, intense photophobia and ocular pain. The patient had long history of uncompensated glaucoma, Graves ophtalmopathy, treated for several years with topical medication without normalizing the intraocular pressure. The patient undergo orbital decompression for Grave’s ophtalmopathy which ameliorated the exophthalmia. Visual assessment showed 0,08 best corrected visual acuity (BCVA) in the right eye respectively 0 in the left eye, posterior chamber pseudophakic implant both eyes, posterior capsular opacification left eye. The intraocular pressure was 18-25 mmHg in the right eye, respectively 14-19 mm Hg under topical medication. The cup-disc ratio was 0.8 in the RE respectively 0.9-1 in the LE. The visual field assessment in the RE showed relative central scotoma, complete lower arcuate (Bjerrum) scotoma, generalized depresion of VF. We performed RE trabeculectomy with 5 fluorouracil and collagen implant (OLOGEN®), with good postoperative evolution. The Visual Acuity improves significantly to 0.1, the IOP after a month was 15 mm Hg. The onset, symptomatology and general clinical context of the patient determined the focus on the neuro-ophthalmological aspect of the case, even if that meant that the control of the glaucoma, at times obviously inefficient, would remain second, from the perspective of its importance.
