Topic outline

  • Grand Rounds

    A patient with a past medical history of intellectual disability and ocular history of constant eye rubbing, a left eye with central retinal venous occlusion and mixed mechanism glaucoma and a right eye that is pseudophakic with open angle glaucoma s/p non-valved glaucoma drainage device placed 4 years ago who presented when his caregiver noticed the patient was having difficulties with ambulation. On examination, visual acuity was hand motion in the right eye (decreased from 20/200) and no light perception in the left eye (baseline). Intraocular pressure (IOP) was 7 mmHg in the right eye and 44 mmHg in the left eye. A slit-lamp examination of the right eye showed a flat anterior chamber, tube-cornea touch, and choroidal effusion. Consequently, surgery was performed to ligate the tube with 7-0 prolene suture, reform the anterior chamber, drain the choroidal effusion, and place an anterior chamber retaining suture with 10-0 prolene. On postoperative day 3, laser suture lysis was performed to reopen the tube due to an IOP of 23 mmHg despite maximal medical therapy. On postoperative week 1, the anterior chamber was flat again with the anterior chamber retaining suture in place. Viscoelastic reformation of the anterior chamber was performed in the clinic. The patient was advised to always wear an eyeshield. The anterior chamber remained deep with IOP in the low teens until postoperative week 6 when the patient stopped wearing the shield. At that time, the patient underwent repeat ligation of the tube and placement of another anterior chamber retaining suture that was 90 degrees from the original suture. Two months after the second surgery, the patient's vision was hand motion. IOP was 20 mmHg on a maximal IOP-lowering regimen, and the anterior chamber remained deep without the eye shield.

    Presentation Date: 02/22/2024
    Issue Date: 03/08/2024