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Glaucoma Case Studies

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

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Glaucoma Case Studies

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

  2. 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

  3. 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: ??

  4. 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

  5. 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

  6. Patient: J.D. • Neuro-ophthalmology consult: B-12 and folate: WNL CT 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 OS HVF stable OU; No visual loss

  7. Visual Fields Pre-Surgery

  8. Visual Fields Post-Surgery

  9. 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

  10. Gonioscopy

  11. Funduscopy

  12. Anterior Ultrasound

  13. 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)

  14. Followed in glaucoma clinic for COAG Noted progressive ↓ invision Referred to retina clinic to evaluate macula VA: 20/50 OD 20/80 OS 0.6 log unit RAPD OS Color 1/15 OU 74 Year Old Female

  15. Optic Disc Exam

  16. Humphrey Visual Fields

  17. Neuroimaging

  18. Neuroimaging

  19. Neuroimaging

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