Vinay Nangia, Ravi Daberao
A CASE PRESENTATION:
A male, 45 years of age, came for a regular follow-up of glaucoma. He was complaining of eye pain since 15 days which was insidious in onset, gradually progressive, intermittent, and associated with mild redness. His best corrected visual acuity was 6/6 in both eyes. Anterior segment examination showed mild conjunctival congestion in the right eye, other findings were within normal limits.
Intraocular pressure was 45 mmHg on latanoprost (0.005%) and brinzolamide (2%) and brimonidine tartrate (0.2%) in right eye and 22 mmHg in left eye on latanoprost (0.005%). The patient was not using antiglaucoma medications regularly. Gonioscopy showed open angles in all quadrants in both eyes.
Impression: The intraocular pressure in the right eye was raised with three anti-glaucoma medications. Fundus showed a cup disc ratio of 0.90, with a classical wedge-shaped defect of RNFL inferiorly. On OCT, the patient has a significant retinal nerve fiber layer and ganglion cell layer thinning in the right eye. The progression in RNFL thinning was also seen in previous scans. (Fig. 2d). In view of the significant glaucomatous damage and for better control of intraocular pressure, the patient was advised of right eye trabeculectomy with mitomycin-C.
Correspondence
Dr. Vinay Nangia
MS, FRCS, FRCOphth
Director
Suraj Eye Institute
Email – education@surajeye.org