Ophtho On Call Case 4: Case continued…

Case 4 Index

 Gonioscopy, is attempted, but the view is poor through the edematous cornea. However, no neovascularization of the iris (NVI) or hyphema is noted. Gonioscopy of the fellow eye is shown below:   

closed gonio horizontal

In this patient, no angle structures are visible on gonioscopy in the left eye, indicating the angle is very narrow. This also suggests that the right eye likely has complete appositional closure, which obstructed aqueous outflow, resulting in extremely high IOP.

For comparison, in an eye with an open angle, the trabecular meshwork should be visible, as seen below:

open gonio with labelAbove Image Credit License: CC-BY SA 3.0

You measure the patient’s glasses and find she is hyperopic with the following prescription:

OD +5.00 sph
OS: +4.50 sph

You orders aqueous suppressant drops and look for a consent form.

What procedure is indicated next?
Peripheral laser iridotomy (LI)
Selective laser trabeculoplasty (SLT)
Laser iridoplasty (Peripheral iris contraction Procedure – PICP)
Intravitreal Anti-VEGF Injection
Panretinal photocoagulation
Glaucoma Drainage Device Implant

Click here to move on!

Case 4 Index

Ophtho On Call Case 4: Introduction
Ophtho On Call Case 4: Physical Exam