Unilateral Angle-Closure Glaucoma with Ciliochoroidal Effusion after the Consumption of Cannabis: A Case Report

A 35-year-old male patient, diagnosed with acute angle-closure glaucoma, did not improve despite intensive treatment with antiglaucoma medications. Ultrasound biomicroscopy revealed a ciliochoroidal effusion. Due to his past history of drug abuse, a urine test was analyzed and found to be positive for cannabis. After topical cycloplegia and oral steroid therapy, his symptoms improved substantially. The present case highlights the role of ultrasound biomicroscopy in evaluating patients with acute angle-closure glaucoma and the role of cannabis abuse in the development of ciliochoroidal effusion

Clinical Efficacy and Safety of the EX-PRESS Filtration Device in Patients with Advanced Neovascular Glaucoma and Proliferative Diabetic Retinopathy

Background: The prognosis of conventional filtration surgery in eyes with neovascular glaucoma (NVG) is limited due to increased fibrovascular proliferation or bleeding. This study aims to evaluate the safety and efficacy of the EX-PRESS filtration device in the management of NVG associated with proliferative diabetic retinopathy (PDR). Methods: In this retrospective case series, we reviewed the medical records of patients diagnosed as having NVG associated with PDR who underwent EX-PRESS filtration surgery. The main outcome measures were: postoperative intraocular pressure (IOP), the percent of IOP drop, the number of glaucoma medications, visual acuity, and complications of surgery. Successful surgery was defined as an IOP <22 mm Hg and >5 mm Hg with or without additional glaucoma surgery, and no loss of light perception or less than a 2-line decrease on the Snellen chart of the best corrected visual acuity (BCVA). Results: Five patients (5 eyes) were included in this study. The mean preoperative IOP was 33.4 ± 5.9 mm Hg compared to an IOP of 17.0 ± 3.0 mm Hg at the last follow-up (p = 0.003). The mean number of preoperative anti-glaucoma medications was 3.8 ± 0.4 compared to 2.2 ± 1.5 (p = 0.06) at the last follow-up visit. Final visual acuity improved or stabilized within 1 Snellen line in all 5 patients. Three patients had a “hypertensive phase” (defined as an IOP >21 mm Hg during the first 6 postoperative months) which resolved within 2 months. Two patients developed a hyphema that resolved spontaneously. None of the patients experienced any serious complications. Conclusion: EX-PRESS filtration device has a good IOP-lowering effect and a low rate of complications in patients with advanced NVG associated with PDR. In addition, there was no loss of light perception or no line decrease of the BCVA

The Prevalence of Polycystic Ovary Syndrome in Women with Idiopathic Intracranial Hypertension

Purpose. The purpose of this study is to re-evaluate whether the prevalence of polycystic ovary syndrome (PCOS) amongst women with idiopathic intracranial hypertension (IIH) is higher than in the general population using the NIH criteria. Methods. We included all consecutive women with IIH of child-bearing age seen at a hospital-based neuro-ophthalmology clinic between the years 2000–2005. All consenting women included in this study filled-out a screening questionnaire aimed at identifying women at risk for PCOS. The endocrinologist examined each patient suspect of PCOS as well as their biochemical results and diagnosed PCOS according to NIH criteria. The prevalence of PCOS in these women with IIH was compared with the reported prevalence of PCOS in the general population. Results. Out of 58 women with IIH who completed the study, definite PCOS was diagnosed in nine women (9/58; 15.5%). We found a significantly higher prevalence of PCOS using the NIH criteria among the IHH study group (15.5%, P=0.001) compared to the general population (8.7%). Conclusions. The prevalence of PCOS is higher among patients with IHH, compared to the general population. We suggest a novel screening questionnaire to aid in the identification of women with IIH at risk for PCOS

Large-Scale Survey of Unselected Automated Visual Fields in a Major Reading Center: Patterns and Data Analysis

A prospective, randomized study was conducted to survey a large number of automated perimetry examinations in a central reading institute, obtaining practical information on unselected referred patients and their clinician “consumers”. Visual field records of 1041 patients were obtained, each evaluated by one of three glaucoma specialists. Statistical analysis was applied on demographics, physician characteristics, test reliability and visual field scores. Reliability was scored on a scale of 1 (excellent) to 5 (uninterpretable). Data from earlier examinations of these patients was also analyzed. The large majority of patients (70.4%) were referred due to glaucoma, ocular hypertension or suspected glaucoma. Most of the patients had threshold strategies: FastPac 24-2 or 30-2 (88.9%), Full Threshold (0.7%), and 10-2 (0.5%). In only 7 patients was short-wavelength automated perimetry (SWAP) performed. The Swedish Interactive Testing Algorithm (SITA) was applied in 1.0% of cases. More than half (56.8%) of the population had a reliability score of 1, and 22.7% had a score of 2, indicating a valid result for 79.4% of patients, providing clinically useful information. Linear regression analyses indicated that the Mean Defect was a better predictor of the visual field score than the Corrected Pattern Standard Deviation (CPSD), for the entire group and for each visual field score subgroup