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Secondary glaucoma in CAPN5-associated neovascular inflammatory vitreoretinopathy.

Cham A, Bansal M, Banda HK, Kwon Y, Tlucek PS, Bassuk AG, Tsang SH, Sobol WM, Folk JC, Yeh S, Mahajan VB - Clin Ophthalmol (2016)

Bottom Line: Patient 3 did not develop steroid-response glaucoma in either eye.The FA implants have reduced uveitic and neovascular glaucoma.Nevertheless, IOP management remains complex due to steroid-response glaucoma, angle closure glaucoma, and hypotony.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences; Omics Laboratory, University of Iowa, Iowa City, IA, USA.

ABSTRACT

Objective: The objective of this study was to review the treatment outcomes of patients with secondary glaucoma in cases of autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), a hereditary autoimmune uveitis due to mutations in CAPN5.

Patients and methods: A retrospective, observational case series was assembled from ADNIV patients with secondary glaucoma. The main outcome measures were intraocular pressure (IOP), visual acuity, use of antiglaucoma medications, ocular surgeries, and adverse outcomes. Perimetry and optic disk optical coherence tomography (OCT) were also analyzed.

Results: Nine eyes of five ADNIV patients with secondary glaucoma were reviewed. Each received a fluocinolone acetonide (FA) implant for the management of posterior uveitis. Following implantation, no eyes developed neovascular glaucoma. Five eyes (in patients 1, 2, and 5) required Ahmed glaucoma valve surgery for the management of steroid-responsive glaucoma. Patient 2 also developed angle closure with iris bombe and underwent laser peripheral iridotomy. Patient 4 had both hypotony and elevated IOP that required periodic antiglaucoma medication in the FA-implanted eye. Patient 3 did not develop steroid-response glaucoma in either eye. Optic disk examinations were obscured by fibrosis and better assessed with OCT.

Conclusion: ADNIV patients show combined mechanism secondary glaucoma best assessed by OCT of the optic disk. The FA implants have reduced uveitic and neovascular glaucoma. Nevertheless, IOP management remains complex due to steroid-response glaucoma, angle closure glaucoma, and hypotony.

No MeSH data available.


Related in: MedlinePlus

Patient 5.Notes: (A) OS optic disk has pink and regular NRR (OD examination was similar to OS examination). (B and C) Humphrey Visual Field 24-2 SITA-Standard protocol with superior and inferior arcuate defects OS > OD, and superior and inferior nasal step defects OU. (D and E) Interval Humphrey Visual Field 24-2 SITA-Standard protocol (obtained 6 years later) demonstrates glaucomatous progression with denser superior arcuate defects OU.Abbreviation: NRR, neuroretinal rim.
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f5-opth-10-1187: Patient 5.Notes: (A) OS optic disk has pink and regular NRR (OD examination was similar to OS examination). (B and C) Humphrey Visual Field 24-2 SITA-Standard protocol with superior and inferior arcuate defects OS > OD, and superior and inferior nasal step defects OU. (D and E) Interval Humphrey Visual Field 24-2 SITA-Standard protocol (obtained 6 years later) demonstrates glaucomatous progression with denser superior arcuate defects OU.Abbreviation: NRR, neuroretinal rim.

Mentions: Five months after her surgery, her IOP measured 22 mmHg OD and 36 mmHg OS despite treatment with topical brimonidine, dorzolamide–timolol, latanoprost, and oral acetazolamide. Her left optic nerve had a pink neuroretinal rim OS (Figure 5A). Her Humphrey visual field (24-2) indicated inferior and superior arcuate defects OU, OS worse than OD (Figure 5B and C). She elected to undergo implantation of an AGV in her left eye for management of her glaucoma. During her postoperative course, she continued to require antiglaucoma drops in both eyes but was able to discontinue oral acetazolamide.


Secondary glaucoma in CAPN5-associated neovascular inflammatory vitreoretinopathy.

Cham A, Bansal M, Banda HK, Kwon Y, Tlucek PS, Bassuk AG, Tsang SH, Sobol WM, Folk JC, Yeh S, Mahajan VB - Clin Ophthalmol (2016)

Patient 5.Notes: (A) OS optic disk has pink and regular NRR (OD examination was similar to OS examination). (B and C) Humphrey Visual Field 24-2 SITA-Standard protocol with superior and inferior arcuate defects OS > OD, and superior and inferior nasal step defects OU. (D and E) Interval Humphrey Visual Field 24-2 SITA-Standard protocol (obtained 6 years later) demonstrates glaucomatous progression with denser superior arcuate defects OU.Abbreviation: NRR, neuroretinal rim.
© Copyright Policy
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4930228&req=5

f5-opth-10-1187: Patient 5.Notes: (A) OS optic disk has pink and regular NRR (OD examination was similar to OS examination). (B and C) Humphrey Visual Field 24-2 SITA-Standard protocol with superior and inferior arcuate defects OS > OD, and superior and inferior nasal step defects OU. (D and E) Interval Humphrey Visual Field 24-2 SITA-Standard protocol (obtained 6 years later) demonstrates glaucomatous progression with denser superior arcuate defects OU.Abbreviation: NRR, neuroretinal rim.
Mentions: Five months after her surgery, her IOP measured 22 mmHg OD and 36 mmHg OS despite treatment with topical brimonidine, dorzolamide–timolol, latanoprost, and oral acetazolamide. Her left optic nerve had a pink neuroretinal rim OS (Figure 5A). Her Humphrey visual field (24-2) indicated inferior and superior arcuate defects OU, OS worse than OD (Figure 5B and C). She elected to undergo implantation of an AGV in her left eye for management of her glaucoma. During her postoperative course, she continued to require antiglaucoma drops in both eyes but was able to discontinue oral acetazolamide.

Bottom Line: Patient 3 did not develop steroid-response glaucoma in either eye.The FA implants have reduced uveitic and neovascular glaucoma.Nevertheless, IOP management remains complex due to steroid-response glaucoma, angle closure glaucoma, and hypotony.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Sciences; Omics Laboratory, University of Iowa, Iowa City, IA, USA.

ABSTRACT

Objective: The objective of this study was to review the treatment outcomes of patients with secondary glaucoma in cases of autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV), a hereditary autoimmune uveitis due to mutations in CAPN5.

Patients and methods: A retrospective, observational case series was assembled from ADNIV patients with secondary glaucoma. The main outcome measures were intraocular pressure (IOP), visual acuity, use of antiglaucoma medications, ocular surgeries, and adverse outcomes. Perimetry and optic disk optical coherence tomography (OCT) were also analyzed.

Results: Nine eyes of five ADNIV patients with secondary glaucoma were reviewed. Each received a fluocinolone acetonide (FA) implant for the management of posterior uveitis. Following implantation, no eyes developed neovascular glaucoma. Five eyes (in patients 1, 2, and 5) required Ahmed glaucoma valve surgery for the management of steroid-responsive glaucoma. Patient 2 also developed angle closure with iris bombe and underwent laser peripheral iridotomy. Patient 4 had both hypotony and elevated IOP that required periodic antiglaucoma medication in the FA-implanted eye. Patient 3 did not develop steroid-response glaucoma in either eye. Optic disk examinations were obscured by fibrosis and better assessed with OCT.

Conclusion: ADNIV patients show combined mechanism secondary glaucoma best assessed by OCT of the optic disk. The FA implants have reduced uveitic and neovascular glaucoma. Nevertheless, IOP management remains complex due to steroid-response glaucoma, angle closure glaucoma, and hypotony.

No MeSH data available.


Related in: MedlinePlus