Vinay Nangia, Ravi Daberao
A CASE PRESENTATION:
A male, 54 years of age, came with the blurring of vision in right eye since 6 months. His best corrected visual acuity was 6/6 partial in right eye and 6/6 in left eye. Anterior segment examination was normal.
Intraocular pressure was 34 mm Hg in right eye and 28 mm Hg in left eye. He was on brimonidine tartrate (0.2%) and timolol maleate (0.50 %) combination eyedrops since 3 years. Gonioscopy showed open angles in all quadrants in both eyes. His axial length in right eye was 23.04 mm and 23.21 mm in left eye. Central corneal thickness was 469 microns in right eye and 468 microns in left eye.
Impression: Patient presented to us with advanced glaucomatous damage in right eye with significant retinal nerve fiber layer and ganglion cell layer thinning in right eye. The relatively thin retinal nerve fiber layer creates a flooring affect. A significantly thin RNFL results in segmentation errors, since the OCT machine is tricked by the prominent blood vessels. This also interferes with the follow up of such subjects on the basis of RNFL damage. The intraocular pressure in right eye was raised in spite of two anti-glaucoma medications. In view of the significant glaucomatous damage, the patient was advised right eye trabeculectomy with mitomycin-C.
Correspondence
Dr. Vinay Nangia
MS, FRCS, FRCOphth
Director
Suraj Eye Institute
Email – education@surajeye.org