Glaucoma Case Studies James C. Tsai, M.D. Associate Professor of Ophthalmology Director, Glaucoma Division Edward S. Harkness Eye Institute Columbia University.

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: WNLCT 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 OSHVF 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 cleft2. 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 COAGNoted progressive ↓ in visionReferred to retina clinic to evaluate macula

VA: 20/50 OD20/80 OS0.6 log unit RAPD OSColor 1/15 OU

Optic Disc Exam

Humphrey Visual Fields

Neuroimaging

Neuroimaging

Neuroimaging