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  • Grand Rounds

    A patient with a history of primary open angle glaucoma of both eyes and myopic degeneration with amblyopia and chronic poor central vision of the right eye presented with elevated intraocular pressure in both eyes. Baseline imaging of the left eye demonstrated inferior peripapillary RNFL thinning with a full visual field. Medical treatment was optimized with improvement in intraocular pressure. After uneventful cataract surgery of the left eye, the patient developed severe ocular surface disease and medication intolerance. SLT was performed without significant effect. After stopping dorzolamide and brimonidine, the ocular surface symptoms resolved but the intraocular pressure rose significantly. Repeat OCT revealed progressive RNFL loss in the left eye. A non-valved glaucoma drainage device was implanted. During the postoperative course, the intraocular pressure trended up. At postoperative week 6, the patient developed sudden dizziness, diplopia, and headaches. Exam revealed left proptosis and a severe left adduction and downgaze motility deficit, as well as an elevated intraocular pressure. Lab workup was unremarkable, and MRI demonstrated a large encapsulated bleb causing mass effect on the left lateral rectus and proptosis. A diagnosis of restrictive strabismus secondary to an encapsulated fibrotic capsule was made. Surgery of the left eye was performed, which included trabeculectomy, tube shunt ligation, and excision of fibrotic capsule. Postoperatively, there was complete resolution of the proptosis and motility disturbance. The intraocular pressure remained controlled off medications following laser suture-lysis of one of the trabeculectomy sutures.

    Presentation Date: 03/23/2023
    Issue Date: 03/31/2023