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Acute angle-closure glaucoma in retinopathy of prematurity following pupil dilation.

Wu SC, Lee YS, Wu WC, Chang SH - BMC Ophthalmol (2015)

Bottom Line: Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values.In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications.Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan.

ABSTRACT

Background: Pupil dilation is a known risk factor for acute angle-closure glaucoma. Regular retinal evaluation is necessary for retinopathy of prematurity (ROP) cases. An acute attack of angle-closure glaucoma following pupil dilation in regressed ROP has never been reported.

Case presentation: A five-year-old girl presented to the hospital for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She had a history of stage 4A ROP in the right eye and received scleral buckling. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) showed that the angle in the right eye was closed 360 degrees circumferentially. In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values. In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye.

Conclusion: Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future. Ophthalmologists should bear in mind that pupil dilation for a retina check-up could result in acute angle-closure glaucoma in ROP patients.

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Related in: MedlinePlus

An acute attack of angle-closure glaucoma following pupil dilation for retinal examination in a five-year-old girl with regressed retinopathy of prematurity. Typical presentations of acute angle-closure glaucoma, including edematous cornea, shallow anterior chamber, fixed-dilated pupil, and glaucomatous flecks of the lens, were observed
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Fig1: An acute attack of angle-closure glaucoma following pupil dilation for retinal examination in a five-year-old girl with regressed retinopathy of prematurity. Typical presentations of acute angle-closure glaucoma, including edematous cornea, shallow anterior chamber, fixed-dilated pupil, and glaucomatous flecks of the lens, were observed

Mentions: A five-year-old girl presented to the Department of Ophthalmology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She received laser treatment for stage 3 ROP. Despite laser treatment, her retinopathy progressed to stage 4A ROP in both eyes. She received scleral buckling for both eyes. The retina was nicely attached in the right eye after scleral buckling, but the retina remained detached and progressed to stage 5 ROP in the left eye. Her prior visual acuity (VA) was 20/200 in the right eye; the left eye displayed no light perception with phthisical changes. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Typical presentations of acute angle-closure glaucoma, including edematous cornea, shallow anterior chamber, fixed-dilated pupil, and glaucomatous flecks of the lens, were observed (Fig. 1). IOP rose to 50 mmHg. Visual acuity in the right eye dropped to finger counting. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) (P40; Paradigm Medical Industries, Inc. Salt Lake City, UT) showed that the angle in the right eye was closed 360 degrees circumferentially (Fig. 2). In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values (Fig. 3). In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye.Fig. 1


Acute angle-closure glaucoma in retinopathy of prematurity following pupil dilation.

Wu SC, Lee YS, Wu WC, Chang SH - BMC Ophthalmol (2015)

An acute attack of angle-closure glaucoma following pupil dilation for retinal examination in a five-year-old girl with regressed retinopathy of prematurity. Typical presentations of acute angle-closure glaucoma, including edematous cornea, shallow anterior chamber, fixed-dilated pupil, and glaucomatous flecks of the lens, were observed
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4528847&req=5

Fig1: An acute attack of angle-closure glaucoma following pupil dilation for retinal examination in a five-year-old girl with regressed retinopathy of prematurity. Typical presentations of acute angle-closure glaucoma, including edematous cornea, shallow anterior chamber, fixed-dilated pupil, and glaucomatous flecks of the lens, were observed
Mentions: A five-year-old girl presented to the Department of Ophthalmology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She received laser treatment for stage 3 ROP. Despite laser treatment, her retinopathy progressed to stage 4A ROP in both eyes. She received scleral buckling for both eyes. The retina was nicely attached in the right eye after scleral buckling, but the retina remained detached and progressed to stage 5 ROP in the left eye. Her prior visual acuity (VA) was 20/200 in the right eye; the left eye displayed no light perception with phthisical changes. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Typical presentations of acute angle-closure glaucoma, including edematous cornea, shallow anterior chamber, fixed-dilated pupil, and glaucomatous flecks of the lens, were observed (Fig. 1). IOP rose to 50 mmHg. Visual acuity in the right eye dropped to finger counting. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) (P40; Paradigm Medical Industries, Inc. Salt Lake City, UT) showed that the angle in the right eye was closed 360 degrees circumferentially (Fig. 2). In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values (Fig. 3). In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye.Fig. 1

Bottom Line: Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values.In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications.Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan 333, Taoyuan, Linkou, Taiwan.

ABSTRACT

Background: Pupil dilation is a known risk factor for acute angle-closure glaucoma. Regular retinal evaluation is necessary for retinopathy of prematurity (ROP) cases. An acute attack of angle-closure glaucoma following pupil dilation in regressed ROP has never been reported.

Case presentation: A five-year-old girl presented to the hospital for a routine retina check-up. The patient was born prematurely with a gestation age of 27 weeks and a body weight of 980 grams. She had a history of stage 4A ROP in the right eye and received scleral buckling. After pupil dilation with 1 % tropicamide and 10 % phenylephrine for retinal examination, acute elevation of intraocular pressure (IOP) was observed in the right eye. Her IOP remained over 50 mmHg in the right eye even under treatment with oral acetazolamide and maximal tolerated doses of topical anti-glaucoma medications. Ultrasound biomicroscopy (UBM) showed that the angle in the right eye was closed 360 degrees circumferentially. In order to lower IOP, trabeculectomy with mitomycin C (0.2 mg/cc) was performed under general anesthesia. Postoperatively, the cornea became clear, the filtering bleb functioned well, and IOP returned to normal values. In the two-year follow-up, IOP was kept around 15 mmHg without anti-glaucoma medications. Although mild lens opacity was noted, her postoperative VA remained 20/200 in the right eye.

Conclusion: Regular retinal evaluation will be necessary for the increasing number of ROP cases to be seen in the future. Ophthalmologists should bear in mind that pupil dilation for a retina check-up could result in acute angle-closure glaucoma in ROP patients.

Show MeSH
Related in: MedlinePlus