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Cataract surgery reveals a case of a double mechanism secondary glaucoma

Poster Details

First Author: A.Ghita ROMANIA

Co Author(s):    A. Ghita   A. Popa-Cherecheanu   R. Ciuluvica        

Abstract Details

Purpose:

To report a case of a pacient with cataract and pseudoexfoliation syndrome (PXF) in both eyes whose diagnosis of secondary glaucoma was difficult due to cataract.

Setting:

University Emergency Hospital, Bucharest

Methods:

88 y.o. pacient with trigeminal neuralgia and ocular pain on the right side presented with reduced visual acuity in both eyes. BCVA RE: 0.05 and BCVA LE: 0.1.At slit-lamp examination: involutional ectropion, cataract and features of PXF in both eyes. IOP RE: 23 mmHg, LE: 17 mmHg. CCT RE: 496µm and 500µm LE. Gonioscopy BE: open-angle, trabecular hiperpigmentation, Sampaolesi line, pseudoexfoliation deposits in the trabeculum; Glaucoma Fast Threshold Perimetry and optic disc examinations couldn’t be interpreted due to cataract. We decided to perform phacoemulsification of the lens, meanwhile, patient received antiglaucoma terapy in both eyes.

Results:

After cataract surgery BCVA BE: 20/20. We made another Glaucoma Fast Threshold Perimetry which showed paracentral scotomata in Bjerrum area in right eye and normal aspect in the left eye. Optic disc examinations (red-free light and OCT) showed reduced retinal nerve fibre layer, more important on the right side. The IOP under antiglaucoma terapy was 13mmHg in RE and 12mmHG LE but, when right orbicular muscle contracts because of right ocular pain induced by trigeminal neuralgia, the IOP RE increases to 17 mmHg.

Conclusions:

Optic nerve head examination was difficult because of the cataract, and an accurate diagnostic of secondary glaucoma couldn’t be done. Glaucomatous damage was according to our examinations more severe on the right side and we think that this is because orbicular muscle contraction and because the pacient was constantly rubbing the right eye due to right trigeminal neuralgia. But, it’s possible that the only cause of this case of secondary glaucoma is pseudoexfoliation syndrome or a combination of both. Cataract surgery was challenging due to combination of poorly dilating pupil, increased risk of zonular dialysis and capsular tear.

Financial Disclosure:

NONE

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