ABSTRACT
BACKGROUND: Diagnostic and therapeutic problems are common in cases of unilateral optical neuropathy with elevated intraocular pressure (IOP) CASE REPORT: A 17-year-old boy was referred for visual acuity loss and elevated IOP at 40mmHg in his left eye. Juvenile open-angle glaucoma (JOAG) was diagnosed based on the clinical and paraclinical examinations. In spite of a maximal hypotensive treatment, tensional control was insufficient and a filtering surgery procedure was necessary. IOP control was good 6 months after surgery, but functional and anatomical analysis showed neuropathic progression and a bilateralization of the disease. CONCLUSION: The diagnosis of JOAG is difficult and sometimes delayed. Secondary bilateralization commonly causes diagnostic problems which can delay specific and appropriate management. Systematic screening should be performed during infancy when a strong family history of glaucoma is known.
Subject(s)
Glaucoma, Open-Angle/diagnosis , Adolescent , Combined Modality Therapy , Disease Progression , Drug Therapy, Combination , Filtering Surgery , Glaucoma, Open-Angle/drug therapy , Glaucoma, Open-Angle/genetics , Glaucoma, Open-Angle/surgery , Humans , Latanoprost , Male , Optic Disk/pathology , Prostaglandins F, Synthetic/administration & dosage , Prostaglandins F, Synthetic/therapeutic use , Timolol/administration & dosage , Timolol/therapeutic use , Tomography, Optical Coherence , Visual FieldsABSTRACT
OBJECTIVES: (1) Evaluate and analyze the Ocular Response Analyzer (ORA) in three groups of patients: glaucoma, intraocular hypertension, and normal; (2) study corneal hysteresis values in the three groups according to age; and (3) compare intraocular pressure values measured with the ORA with intraocular pressure measured with Goldmann (IOPGoldmann) and pulsed air (IOPair) applanations. MATERIAL AND METHODS: This prospective, single-center study included 329 eyes divided into three groups: normal (n=207), intraocular hypertension (n=55), and primary angle glaucoma (n=67). Corneal hysteresis (CH), IOP corneal-compensated (IOPcc), and Goldmann correlated IOP (IOPg) measurements were provided by the ORA device for all patients. Ultrasonic central corneal thickness (CCT US), and intraocular pressure measured with Goldmann and pulsed air tonometry were also assessed in each eye. RESULTS: The mean values were: IOPGoldmann 14.4+/-3.4 mmHg, IOPair 15.5+/-3.6 mmHg, CCT 542.1+/-36.6 microm, CH 10+/-1.7 mmHg, IOPcc 16.6+/-4.1 mmHg, and IOPg 15.7+/-3.9 mmHg. All the IOP measurements (IOPGoldmann, IOPair, IOPg, IOPcc) were strongly correlated into the three age groups. The mean CH in the glaucoma (9.8 mmHg) and intraocular hypertension (9.6 mmHg) groups was lower than in the normal group (10.3 mmHg), but there was no difference between the three groups for the CH values, with an age-related analysis of the three groups. The CH was correlated with CCT US in the three groups. IOP measures were not strongly correlated with CH except for IOPcc. There was a negative correlation (-0.79) between CH and IOPcc. DISCUSSION/CONCLUSION: In our study, the mean ORA, CCT US, and IOP values in the normal group were similar to those found in the literature. These are the first CH values reported for a normal group according to age. We confirm the good correlation between all the IOP measurements. The mean corneal hysteresis value was low in glaucoma and intraocular hypertension, but there was no difference between the three groups for the CH values, when the three groups were analyzed according to age. There was a correlation between corneal hysteresis and central corneal thickness. Moreover, IOPcc seems to be the best evaluation of IOP with no influence from corneal biomechanical factors. The Ocular Response Analyzer and corneal hysteresis should be considered a useful parameter for patients with intraocular hypertension and/or glaucoma.
