Depression and Anxiety in Patients with Glaucoma or Glaucoma Suspect

PURPOSE: To investigate depression and anxiety in patients with glaucoma or glaucoma suspect. METHODS: Seventy-two patients with glaucoma, 72 patients with glaucoma suspect and 26 controls comprised the study population. Anxiety and depression was evaluated by hospital anxiety and depression scale (HADS) questionnaire. In this study, scores higher than 10 on the HADS-A and HADS-D were defined as anxiety and depression, respectively. The relationship between HADS and mean deviation (MD) of visual field tests or visual acuity of the better eye was analyzed in glaucoma patients. RESULTS: Three (11.5%) controls, 11 (15.3%) patients with glaucoma suspect, and 15 (20.8%) patients with glaucoma had anxiety. One (3.8%) control, 5 (6.9%) patients with glaucoma suspect, and 15 (20.8%) patients with glaucoma had depression. In glaucoma patients, the number of anxiety patients was higher in patients who had MD of less than -6 dB and the numbers of anxiety and depression patients were higher in patients who had visual acuity of lower than 20/40. CONCLUSIONS: The rate of depression in patients with glaucoma is higher than that of glaucoma suspect and controls. There is no significant difference between the three groups in rate of anxiety. Clinicians are advised to not only offer medical treatment but also should monitor for mood disturbances like anxiety and depression to ensure compliance and quality of life of patients.

Depression and Anxiety in Patients with Glaucoma or Glaucoma Suspect

PURPOSE: To investigate depression and anxiety in patients with glaucoma or glaucoma suspect. METHODS: Seventy-two patients with glaucoma, 72 patients with glaucoma suspect and 26 controls comprised the study population. Anxiety and depression was evaluated by hospital anxiety and depression scale (HADS) questionnaire. In this study, scores higher than 10 on the HADS-A and HADS-D were defined as anxiety and depression, respectively. The relationship between HADS and mean deviation (MD) of visual field tests or visual acuity of the better eye was analyzed in glaucoma patients. RESULTS: Three (11.5%) controls, 11 (15.3%) patients with glaucoma suspect, and 15 (20.8%) patients with glaucoma had anxiety. One (3.8%) control, 5 (6.9%) patients with glaucoma suspect, and 15 (20.8%) patients with glaucoma had depression. In glaucoma patients, the number of anxiety patients was higher in patients who had MD of less than -6 dB and the numbers of anxiety and depression patients were higher in patients who had visual acuity of lower than 20/40. CONCLUSIONS: The rate of depression in patients with glaucoma is higher than that of glaucoma suspect and controls. There is no significant difference between the three groups in rate of anxiety. Clinicians are advised to not only offer medical treatment but also should monitor for mood disturbances like anxiety and depression to ensure compliance and quality of life of patients.

A Case of Acute Incomitant Esotropia Associated with Wernike's Encephalopathy

PURPOSE: We report a case of an acute incomitant esotropia with Wernike's encephalopathy. CASE SUMMARY: A 64-year-old male visited our hospital because of diplopia lasting a week. He was a chronic alcoholic drinking two bottles of makgeolli daily and eating little for a month. He showed -2 underaction of bilateral lateral rectus muscles and 45 prism diopters of esotropia at the primary position at the first visit. He had ataxia and mild cognitive impairment. There were high signal intensities in the periaqueductal area and mammillary bodies in the brain fluid attenuated inversion recovery magnetic resonance image. He was diagnosed with Wernike's encephalopathy clinically and was immediately treated with intravenous thiamine. He showed -0.5 underaction of bilateral lateral muscles and 8 prism diopters of esotropia at the primary position 3 days after thiamine treatment. CONCLUSIONS: Wernicke's encephalopathy is a medical emergency. If diagnosis and treatment are delayed, patients may have neurological sequelae that can lead to death. Esotropia and diplopia can be the presenting manifestations in Wernike's syndrome without other symptoms. In taking patient histories, physicians should ask about alcohol consumption and low food intake because of the possibility of acute incomitant esotropia associated with Wernicke's encephalopathy.

Nasolacrimal Duct Obstruction after Radioactive Iodine Therapy for Thyroid Cancer

PURPOSE: To investigate the clinical manifestation of nasolacrimal duct obstruction after radioactive iodine therapy for thyroid cancer. METHODS: The authors examined 622 patients who were treated with radioactive iodine therapy after the operation for thyroid cancer from January 2009 to December 2011. Fourteen patients (18 eyes) were diagnosed nasolacrimal duct obstruction based on the lacrimal irrigation test, lacrimal probing test and dacryocystography in our oculoplastic clinic. We analyzed the dose of radioactive iodine therapy, number of treatments, clinical manifestation and treatment type by retrospectively reviewing the patients' medical records. RESULTS: The mean radioactive iodine dose (215.7 +/- 23.1 mCi, p = 0.01) and the mean number of treatments (1.36 +/- 0.50, p< 0.001) were significantly greater in 14 patients who had nasolacrimal duct obstruction than in patients who did not. The average onset of tearing symptoms occurred 10.2 months after radioactive iodine therapy. The mean time between correct diagnosis and therapy was 18.4 months. Three patients (3 eyes) had occlusion at the common cannaliculus and 11 patients (15 eyes) had occlusion at the nasolacrimal duct. Ten patients (13 eyes) underwent endonasal dacryocystorhinostomy for complete obstruction and 4 patients (5 eyes) underwent silicone tube intubation for partial obstruction. CONCLUSIONS: Nasolacrimal duct obstruction is a rare complication associated with radioactive iodine therapy for thyroid cancer, thus, clinicians should be aware of this complication and refer patients with symptoms of epiphora to the oculoplastic department for specialized evaluation and treatment.

A Case of Intravitreal Bevacizumab Injection for the Treatment of Choroidal Neovascularization in Morning Glory Syndrome

PURPOSE: We report a case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in morning glory syndrome. CASE SUMMARY: A 51-year-old male visited our hospital for a 1.5-year visual disturbance in his right eye. The patient's best-corrected visual acuity was 0.1 in the right eye. After fundus examination, we found characteristic findings of morning glory syndrome with submacular hemorrhage and serous retinal detachment in the right eye. Optical coherence tomography, fluorescein angiography and indocyanine green angiography were performed for evaluation. Retinoschisis, subretinal fluid, and choroidal neovascularization were detected, and thus bevacizumab was injected in the right eye. After intravitreal bevacizumab injection, retinoschisis was improved, and subretinal fluid was decreased. However, retinal pigment epithelial detachment was newly detected, and serous retinal detachment persisted. After 2 months, a second bevacizumab injection was performed. After these intravitreal bevacizumab injections at 1 and 2 months, visual acuity was 0.4 and 0.6, respectively. Visual acuity improved to 1.0 after 3 months. Visual acuity was maintained for at least 6 months with no relapse of choroidal neovascularization. CONCLUSIONS: The choroidal neovascularization in morning glory syndrome was effectively treated with intravitreal bevacizumab injections.