Content area
Full Text
Introduction
Laser iridotomy can relieve a relative pupillary block and open the angles in primary angle closure disease (PACD) patients [1]. Although laser iridotomy had been accepted as a first-choice therapy for PACD, several postoperative complications have been reported such as iritis, corneal edema, transient elevation of intraocular pressure (IOP), or closure of iridotomy hole [2]. Choroidal detachment and retinal detachment [3] following argon laser peripheral iridotomy (LPI) in a patient with acute primary angle closure (APAC) has been reported. Using ultrasound biomicroscopy (UBM), uveal effusion in PACD eyes with or without LPI has been reported [4-7]. To study the relation between uveal effusion and laser iridotomy, we observed a temporal course of uveal effusion using UBM in a patient with APAC.
Case Report
A 59-year-old woman was seen by an ophthalmologist for blurred vision, ocular pain, headache, and nausea. She had no notable medical history. On initial examination, her IOP was 70 mm Hg in the right eye (RE) and 14 mm Hg in the left eye (LE) by non-contact tonometry. Slit-lamp examination showed dilated pupil and corneal edema in her right eye, and bilateral shallow anterior chamber. She was diagnosed with APAC. Then oral acetazolamide 500 mg and 2% pilocarpine eye drop every 1 h were given, and she was referred to the glaucoma clinic at Ryukyu University Hospital immediately. On the same day, IOP was RE, 56 and LE, 12 mm Hg by Goldmann tonometry in our clinic. Intravenous injection of 300 mL mannitol was performed and topical 0.5% timolol twice daily was started and 2% pilocarpine eye drop was continued every 15 min. During these medical treatments, UBM (model UX-02, Rion, Tokyo) examination was performed. UBM examination showed closed angle with engorged episcleral veins. Supraciliary space was not observed by UBM at this time (Fig 1a, b). On the next day, IOP of the right eye came down to 9 mm Hg by medical treatment. Slit-lamp examination showed Descemet’s membrane fold and (+++) cells in the anterior chamber of the right eye. UBM examination was repeated and revealed narrow but open angle circumferentially and engorged episcleral veins. Uveal effusion was again not evident (Fig 1c, d). Topical 2% pilocarpine 4 times daily was applied for both eyes. Axial lengths measured by...