To evaluate the efficacy of amniotic membrane in the management of painful bullous keratopathy secondary to the intractable glaucoma and in preventing exposure of drainage devices, we inserted Ahmed valve with amniotic membrane patch graft over the implant itself, and debrided corneal epithelium with amniotic membrane graft over the exposed stroma as a single operation. During the follow-up periods, we monitored vision, intraocular pressure (IOP), presence of ocular pain, and postoperative complications associated with the implants. The mean follow up period was 8.4+/-3.2 months. IOP was well controlled after the intervention. The preoperative mean IOP was measured as 43.9+/-9.0 mmHg and lowered to 16.1+/-1.8 mmHg at the last visit and no complications associated with the implants were noted. Even though the improvement in vision was not prominent, the ocular surface stabilized rapidly and ocular pain associated with bullous keratopathy disappeared soon after surgery. Conclusively the use of amniotic membrane in conjunction with Ahmed valve implantation is an effective way to relieve ocular pain and lessen the chances of complications associated with the implant in patients with intractable glaucoma and bullous keratopathy.
Retrospective Studies ; Middle Aged ; Male ; Humans ; *Glaucoma Drainage Implants ; Glaucoma/complications/surgery ; Female ; Epithelium, Corneal/pathology/surgery ; Corneal Transplantation/*methods ; Corneal Diseases/etiology/pathology/*surgery ; Amnion/*transplantation ; Aged

PURPOSE: To report a case of acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment. METHODS: An 81-year-old woman visited our emergency room for severe ocular pain and vision loss in her left eye. Her intraocular pressures (IOPs) were 14 mmHg in the right eye and 58 mmHg in the left eye. Her visual acuity was 0.4 in the right eye but she had no light perception in the left eye. The left anterior chamber depth was shallow and gonioscopy of the left eye showed a closed angle. In comparison, the right anterior chamber depth was normal and showed a wide, open angle. Computed tomography and ultrasonography demonstrated retinal detachment due to subretinal hemorrhage. After systemic and topical antiglaucoma medications failed to relieve her intractable severe ocular pain, she underwent enucleation. RESULTS: The ocular pathology specimen showed that a large subretinal hemorrhage caused retinal detachment and pushed displaced the lens-iris diaphragm, resulting in secondary angle-closure glaucoma. CONCLUSIONS: Prolonged anticoagulant therapy may cause hemorrhagic retinal detachment and secondary angle-closure glaucoma. If medical therapy fails to relieve pain or if there is suspicion of an intraocular tumor, enucleation should be considered as a therapeutic option.
Tomography, X-Ray Computed ; Retinal Hemorrhage/*complications/pathology/radiography ; Retinal Detachment/*etiology/pathology/radiography ; Humans ; Glaucoma, Angle-Closure/*etiology/surgery ; Female ; Eye Enucleation ; Aged, 80 and over ; Acute Disease

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects

A 60-year-old man visited our clinic with a sudden blurred vision and ocular pain in his right eye occurring 15 years after cataract surgery. The intraocular pressure (IOP) was 55 mmHg in the right eye and gonioscopy revealed a wide open angle with white cortical lens material in the inferior angle. Since the IOP was unable to be controlled with medical therapy, removal of the lens material was performed by irrigation and aspiration. Following surgery, the IOP was decreased to 18 mmHg without medication and the patient's vision recovered to 20/20. The pathology of the aqueous humor showed macrophages with engulfed lens particles.
Aqueous Humor/*cytology ; Case Report ; Cataract Extraction/*adverse effects ; Glaucoma/*etiology/*pathology ; Human ; Lens, Crystalline/*pathology ; Macrophages/pathology ; Male ; Middle Age

A 32-year-old man with blurred vision in the right eye and headache presented with anterior uveitis, an intraocular pressure (IOP) of 60 mmHg, an open angle, no visual field defects, and normal optic nerve. He had a history of five previous similar attacks. In each of the previous instances, his anterior uveitis and high IOP were controlled with antiglaucoma medications and topical steroids. However, at the fifth attack, his optic disc was pale and a superior paracentral visual field defect was shown. Brain magnetic resonance image studies were normal. This case represents that a recurrent Posner-Schlossman syndrome (PSS)-induced optic disc atrophy likely due to ocular ischemia caused by a recurrent, high IOP. Although PSS is a self-limiting syndrome, we should manage high IOP and prevent ischemia of the optic nerve head by treating with ocular antihypertensive medications.
Atrophy/diagnosis/etiology ; Diagnosis, Differential ; Glaucoma, Open-Angle/*complications/diagnosis/physiopathology ; Humans ; *Intraocular Pressure ; Male ; Optic Disk/*pathology ; Optic Nerve Diseases/diagnosis/*etiology/physiopathology ; Syndrome ; Young Adult

PURPOSE: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT). METHODS: SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral beta-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized. RESULTS: Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA beta-zone of all eyes, and no eye showed an IS/OS complex in the beta-zone. The BRL was absent in the beta-zone of two eyes. The BRL was incomplete or showed posterior bowing in the beta-zone of five eyes. CONCLUSIONS: The common findings in the PPA beta-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the beta-zone areas.
Adult ; Aged ; Bruch Membrane/pathology ; Female ; Glaucoma/*complications ; Humans ; Male ; Middle Aged ; Nerve Fibers/pathology ; Optic Atrophy/*diagnosis/*etiology ; Optic Disk/*pathology ; Photoreceptor Cells, Vertebrate/pathology ; Retina/pathology ; Retinal Pigment Epithelium/pathology ; Tomography, Optical Coherence/*methods

PURPOSE: We describe the occurrence of a massive retinal hemorrhage following anterior chamber paracentesis in uveitic glaucoma. METHODS: A 33-year-old man who suffered from uveitic glaucoma was transferred to our hospital. The IOP in both his eyes was documented to vary between 11 mmHg and 43 mmHg and remained at a continuously high level for 7 months despite maximally tolerable medical treatment. A paracentesis was performed bilaterally to lower the IOP. RESULTS: Immediately after the paracentesis, massive retinal hemorrhages occurred in the left eye. Multiple round blot retinal hemorrhages with white centers occurred in the equator and peripheral retina, and small slit hemorrhages were observed in the peripapillary area. A fluorescence angiography(FAG) showed no obstruction of retinal vessels but a slightly delayed arteriovenous time in the left eye. CONCLUSIONS: It is important to be aware that patients who have a persistent relatively high IOP are at an increased risk of developing decompression retinopathy due to paracentesis and filtering surgery.
Uveitis, Anterior/*surgery ; Retinal Hemorrhage/*etiology/pathology ; Paracentesis/*adverse effects ; Male ; Intraocular Pressure ; Humans ; Glaucoma/*surgery ; Fundus Oculi ; Follow-Up Studies ; Fluorescein Angiography ; Anterior Chamber/*surgery ; Adult

OBJECTIVETo explore the relationship between neuroretinal rim area (RA) /retinal nerve fiber layer (RNFL) thickness and differential light sensitivity (DLS) in visual field in primary open angle glaucoma (POAG).

METHODSFifty-one eyes of 51 patients with POAG were examined with HRT II, GDx VCC, and Octopus 101 for RA, RNFL thickness, and DLS. Their correlations were evaluated with linear and logarithmic regression models globally and for individual sectors.

RESULTSIn all the considered patients, visual field DLS was significantly correlated with neuroretinal RA or RNFL thickness globally and in individual sectors. Logarithmic fits were significantly better than linear fits for the global data and in most sectors. In preperimetric glaucoma, such correlations were weak and linear (R2 = 0.01-0.26). However, in perimetric glaucoma, the correlations were much stronger and curvilinear model gave the better fit (R2 = 0.15-0.84). Neuroretinal RA and RNFL thickness were linearly correlated.

CONCLUSIONNeuroretinal RA, RNFL thickness, and DLS in visual field were well correlated in POAG.

Adult ; Aged ; Aged, 80 and over ; Female ; Glaucoma, Open-Angle ; pathology ; physiopathology ; Humans ; Male ; Middle Aged ; Nerve Fibers ; pathology ; Optic Disk ; pathology ; Photophobia ; etiology ; Regression Analysis ; Retina ; pathology ; Visual Fields ; physiology ; Young Adult

PURPOSE: To document the clinical features of disc hemorrhage in patients with branch retinal vein occlusion (BRVO) and normal tension glaucoma (NTG), and to evaluate the relationship between BRVO and NTG with disc hemorrhages. METHODS: From July 2001 to May 2006, sixteen patients with both NTG and BRVO in different eyes were successively collected from outpatient population of Seoul National University Hospital in this observational case series. The frequency and location of disc hemorrhages, history of associated systemic diseases, and the order of the time of diagnosis between NTG and BRVO were studied. RESULTS: All patients had unilateral BRVO, and their mean age was 63.3+/-10.6 years. Disc hemorrhages were detected in eight patients (50%) during the mean follow-up of 26.8 months (range, 3-96 months). Six patients (75%) had disc hemorrhages in the non-BRVO eyes and two patients (25%) in BRVO eyes. Five hemorrhages (62.5%) were located at inferior-temporal quadrant of the optic disc. History of systemic hypertension was identified in 12 patients (75.0%). In 11 patients (68.8%), NTG was diagnosed at the same time as BRVO. CONCLUSIONS: A higher frequency of disc hemorrhages was identified in patients with both BRVO and NTG. Therefore, some cases of NTG, especially with disc hemorrhages, may share a common vascular pathophysiology with BRVO.
Adult ; Aged ; Eye Hemorrhage/*etiology/pathology/physiopathology ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glaucoma, Open-Angle/*complications/pathology/physiopathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Optic Disk/*pathology ; Optic Nerve Diseases/*etiology/pathology/physiopathology ; Retinal Vein Occlusion/*complications/pathology ; Retrospective Studies ; Severity of Illness Index ; Visual Acuity