Transcript Current Glaucoma Management

Glaucoma Case Studies
James C. Tsai, M.D.
Associate Professor of Ophthalmology
Director, Glaucoma Division
Edward S. Harkness Eye Institute
Columbia University
LD: Clinical
•
•
•
•
•
•
•
History & Exam
78 y/o woman with glaucoma x 7 months
PMHx: hypothyroid; Meds: Synthroid, Premarin
Ocular Hx: negative; on Xalatan qhs OU
Va: 20/40 OU, Ta: 17 OD, 22 OS (9:25 AM)
SLE: 2+ NSC OU (+ PXE flakes), A/C D&Q
Gonio: Grade II-III OU; CCT: 518 OD, 533 OS
C/D ratio: 0.75 OD, 0.85 OS; thin temporally OU
LD:
Clinical Assessment
• HVF: OD: WNL, OS: inf. arcuate defect/nasal step
• OCT3: OD: 88.0 microns, OS: 74.75 microns
• Imp: PXF glaucoma w/ uncontrolled IOP (OS>OD)
? Thin CCT OU a risk factor
Target IOP: mid-teens OU
• Treatment Plan: ??
Patient: J.D.
• 47 y.o. M w/ COAG & recurrent erosions
• FHx of POAG, Myopia (-4 to -6 D)
• Va 20/20 OU; IOP 18 OD, 16 OS
• cc: grayer & darker vision (OD > OS)
• C/D = 0.8 OD, 0.7 OS (cupped temporally)
• Meds: Betaxolol, Propine
Patient: J.D.
• Initial ALT OD, followed by ALT OS
• 1 year later: c/o worse vision (OS > OD)
• Va 20/20 OU; IOP 10 OD, 11 OS
• Diurnal curve: peak of 13 OU
• HVF: worse OU
• C/D = 0.9 OD; 0.85 OS
Patient: J.D.
• Neuro-ophthalmology consult:
B-12 and folate: WNL
CT of orbits: WNL
• 3 months later: IOP 16 OU; cc: OS dimmer
• TBX w/ MMC OS & OD 2 months later
• 5 year F/U: Va 20/20 OU; IOP 10 OD, 9 OS
HVF stable OU; No visual loss
Visual Fields Pre-Surgery
Visual Fields Post-Surgery
Case Presentation
•
•
•
•
•
•
15 year old boy S/P trauma OD (tennis ball)
Cc: Blurred vision OD x 3 months
PMHx: negative
Va: 20/200 OD, 20/20 OS
IOP: 4 mm Hg OD, 15 mm OS
SLE (OD): deep A/C, trace RBCs
Gonioscopy
Funduscopy
Anterior Ultrasound
Assessment
• Ocular hypotony OD (with maculopathy)
• Cyclodialysis cleft with concomitant
angle recession
• Treatment:
1. Argon laser closure of cleft
2. Surgical closure of cleft
• Need to monitor for post-op IOP spike
(? Concurrent Stage 1 glaucoma tube)
74 Year Old Female
Followed in glaucoma clinic for COAG
Noted progressive ↓ in vision
Referred to retina clinic to evaluate macula
VA: 20/50 OD
20/80 OS
0.6 log unit RAPD OS
Color 1/15 OU
Optic Disc Exam
Humphrey Visual Fields
Neuroimaging
Neuroimaging
Neuroimaging