Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Optic Neuritis Mimicking Ischemic Optic Neuropathy and Optic Glioma

PURPOSE: To report a case of optic neuritis difficult to differentiate from ischemic optic neuropathy and optic nerve glioma. CASE SUMMARY: A 63-year-old male visited our clinic because of a sudden painless decrease in visual acuity in his right eye. He had a relative afferent pupillary defect and inferior altitudinal scotoma with disc pallor in his right eye. Ischemic optic neuropathy was suspected based on these clinical observations. However, a focal enhancing lesion was found in the intracranial portion of the right optic nerve on gadolinium-enhanced T1-weighted MRI. The radiologist's report revealed right intracranial optic glioma. Optic neurectomy was planned in accordance with the suspicion for optic glioma. However, a systemic mega-dose methylprednisolone therapy which is relatively less invasive was performed first based on the decision that optic neuritis should be distinguished from optic nerve glioma. The patient was hospitalized and 1 gram of methylprednisolone was injected intravenously daily for 3 days. The patient's visual acuity in the right eye improved from 0.1 before treatment to 0.3 after treatment. MRI scans at 8 months after steroid treatment showed disappearance of the previously enhanced lesion suspicious for optic glioma with developed atrophic change. The patient was finally diagnosed with optic neuritis based on these results. CONCLUSIONS: Careful differential diagnoses and therapeutic approaches to possible diseases are necessary because optic neuritis can manifest as a variety of clinical entities and imaging findings.