Author: Dr. Marcelo Nicolela and Dr. Tianwei Ellen Zhou
A 65-year-old Asian male was referred by his general ophthalmologist for high intraocular pressure (IOP) in the left eye secondary to pigment dispersion syndrome.
The patient was found to have unilateral high IOP of 52 mmHg in the left eye approximately three months ago. He did not experience pain or discomfort in the left eye during this period and he did not notice any subjective visual field changes. He did report long-standing floaters in both eyes, more pronounced in the left. On examination, the patient was found to have open angles in both eyes, described as “open angles with some pigment”. The patient was started on two glaucoma drops, Vyzulta® (latanoprostene bunod 0.024%) and the combination drop Azarga® (brinzolamide/timolol).
The patient returned a week later for an IOP measurement, which had reduced to 25 mmHg in the left eye. His ophthalmologist then performed a dilated fundus exam and observed an inferior retinal detachment at the far periphery. The ophthalmologist subsequently performed laser retinopexy and suggested that the retinal detachment might have been chronic because some pigment was already present at the border.
The patient continued his two glaucoma drops but the IOP remained elevated, fluctuating between 25-30 mmHg and the patient was therefore referred to a glaucoma subspecialist.
• Past medical history (PMI): Hypertension and dyslipidemia.
• Post ocular history (POH): Uneventful cataract surgeries with PCIOL in both eyes 5 years ago.
• History of trauma: None.
• Medications: Azarga BID and Vyzulta QHS for the left eye.
Examination:
Gonioscopy:
very interesting case
Super interesting cases.
Interesting case…Thank you
super interesting
It is super interesting, knowing more that I didn’t know before
Interesting case.Never seen such a case
Good case for a general practitioner to have in mind
Profound
Brilliant case
Very interesting case
Interesting Questions
Very interesting case and absolutely educative
Very educative case
Good
Un cas extrêmement intéressant et riche en enseignements !
Interesting and educative case!!
Quite educative!
very interesting and detailed case! well done
excellent and very interesting case thank you
Very nice informative case
Thank you
Me encantó el caso y las lecturas complementarias. Muy enriquecedor. Gracias
Nice case for learning
Insightful…looking forward to more such interesting cases
Enjoyed solving the quiz. Nice case and very interestingly framed questions!
Thank you,
Very good case as usual. In 15 years, I saw one case like this.
It’s not just a single case scenario —very informative
Excelent case! always leraning!
Wow
Very interesting and educative
Great learning 👍
My answer was h/o cataract surgery becoz I thought the RD might have occurred due to peribulbar block
VERY EDUCATIVE
Very nice case
Productive
Thank you so much for such practical questions
A very comprehensive question
A good test for review
Wonderful case!!!
Intersting case, its just wondering iop 52mmHg and there is no eye pain
Interesting case…