Primary Angle Closure Glaucoma

A 73-year-old Hispanic female presented to Bascom Palmer Eye Institute emergency room on June 06, 2019 with complaints of decreased vision and intermittent pain in the left eye. The patient has no past medical and a history of hyperopia both eyes. Humphrey visual field (HVF) and ocular nerve and retinal nerve fiber layer (RNFL) imaging identified advanced glaucoma damage in both eyes. The patient was diagnosed with primary angle closure disease (PACD), underwent bilateral laser peripheral iridotomy (LPI) and combined cataract and glaucoma surgeries in both eyes. The patient was lost to follow-up due to the coronavirus pandemic and six months later, the patient had bilateral choroidal effusions on examination. The patient has been treated with topical corticosteroids and cycloplegia with stable visual acuity and intraocular pressure (IOP). Patients with hyperopia and short axial length have thick/rigid sclera which can cause constriction of blood flow through scleral vessels. These are significant risk factors for PACD. Consequently, intraocular surgery is commonly complicated by choroidal effusion and exudative RD (“uveal effusion syndrome”). The patient can be treated with medical management. If the patient develops vision loss or hypotony, surgery can be considered to revise the trabeculectomy in the right eye.

Presentation Date: 12/03/2020

Issue Date: 06/25/2021