Bilateral angle-closure during hospitalization for coronavirus disease-19 (COVID-19): A case report.

PURPOSE: This report describes a case of bilateral primary angle closure (PAC) progressing to unilateral end-stage primary angle closure glaucoma (PACG) associated with treatment for coronavirus disease-19 (COVID-19) infection. METHODS: A 64-year-old man came to our attention because of blurred vision after a 2-month hospital stay for treatment of COVID-19 infection. Examination findings revealed PACG, with severe visual impairment in the right eye and PAC in the left eye due to plateau iris syndrome. The patient's severe clinical condition and prolonged systemic therapy masked the symptoms and delayed the diagnosis. Medical chart review disclosed the multifactorial causes of the visual impairment. Ultrasound biomicroscopy (UBM) aided in diagnosis and subsequent therapy. RESULTS: The cause behind the primary angle closure and the iridotrabecular contact was eliminated by bilateral cataract extraction, goniosynechialysis, and myotic therapy. CONCLUSIONS: COVID-19 treatment may pose an increased risk for PAC. Accurate recording of patient and family ophthalmic history is essential to prevent its onset. Recognition of early signs of PAC is key to averting its progression to PACG.

Comparison between Fundus Automated Perimetry and Humphrey Field Analyzer: Performance and usability of the Fundus Automated Perimetry and Humphrey Field Analyzer in healthy, ocular hypertensive, and glaucomatous patients.

PURPOSE: We compared the performance and usability of the Fundus Automated Perimetry (FAP) and Humphrey Field Analyzer (HFA) in patients with glaucoma, ocular hypertension, and healthy subjects. MATERIALS AND METHODS: A total of 60 participants, divided in three groups of 20, glaucoma (POAG), ocular hypertension (OHT), and controls group, underwent a HFA test 24-2 SITA standard and a FAP test 24-2 ZEST sequence, in randomized order. The mean differences between perimeters of mean deviation (MD), pattern standard deviation (PSD) were correlated using the t-test and the Bland-Altman plot while execution time, Glaucoma Staging System 2 (GSS2), Hodapp-Parrish-Anderson staging system, localization of the defect, false positives (FP), and false negatives (FN) were compared with t-test analysis. Usability was measured through answers of a dedicated questionnaire. RESULTS: MD's difference was higher for FAP than HFA: OHT -2.20 ± 1.33 dB (p < 0.001), POAG -2.00 ± 1.66 dB (p < 0.001), and controls -1.08 ± 1.43 dB (p < 0.001). PSD's difference was higher for FAP than HFA: OHT 0.85 ± 1.16 dB (p < 0.001), POAG 0.78 ± 2.32 dB (p = 0.043), and controls 0.49 ± 1.15 dB (p < 0.001). GSS2's difference showed that FAP found more severe defects than HFA. Exams duration was longer for FAP versus HFA: in OHT 363 s versus 301 s, in POAG 494 s versus 362 s, and in controls 360 s versus 277 s. For FN and FP, there were no statistically significant differences. The 77% of all subjects preferred FAP to HFA test. CONCLUSION: Considering MD and GSS2 classification, FAP finds more severe defects. Moreover, although FAP duration is longer, this method is preferred by most of the patients.

SD-OCT Choroidal Thickness in Advanced Primary Open-Angle Glaucoma.

PURPOSE: To assess the choroidal thickness in advanced primary open-angle glaucoma (POAG) comparing patients affected by advanced glaucoma and normal subject using spectral domain optical coherence tomography (SD-OCT). METHODS: In total, 35 eyes of 35 patients affected by POAG with advanced perimetric defect (mean deviation worse than -12 dB) were prospectively enrolled and underwent a complete ophthalmologic examination, including enhanced depth imaging SD-OCT. One eye of 35 healthy subjects served as control group. Choroidal thickness was measured at the subfoveal location, at 0.5, 1.0, and 2.0 mm nasal and temporal to the fovea. Primary outcome measure was the identification of different choroidal thickness between advanced glaucoma patients and normal subjects. RESULTS: Glaucoma and control group were homogenous for age, sex, and axial length (P>0.05 in all cases). A significant difference was found in the subfoveal choroidal thickness (SFCT) adjusted for age and axial length between glaucoma and control eyes (P=0.042); in glaucoma patients the mean adjusted SFCT was 209.90 µm compared with 234.78 µm in control subjects. Both temporal and nasal choroidal thickness measurements followed the same SFCT trend, even if only temporal ones were statistically significant. We also found that SFCT decreased with age and increased axial length (P=0.007 and 0.001, respectively). Sex and intraocular pressure did not significantly influence the choroidal thickness (P=0.87 and 0.35, respectively). CONCLUSIONS: Patients affected by advanced POAG damage have a thinner choroidal thickness compared with normal subjects, using SD-OCT. We also confirmed that age and axial length were the main factors affecting choroidal thickness in these patients.

Simultaneous bilateral acute angle-closure glaucoma in a patient with subarachnoid hemorrhage.

PURPOSE: To present an unusual case of simultaneous bilateral acute angle-closure (AAC) glaucoma in a patient with subarachnoid hemorrhage due to an aneurysm involving the right middle cerebral artery. METHODS: A 60-year-old woman with a clinically inexplicable bilateral nonreacting mydriasis after brain surgery underwent an ophthalmologic consultancy. The bilateral mydriasis was diagnosed as an unusual clinical presentation of simultaneous bilateral AAC glaucoma. One week after the AAC was bilaterally resolved, the patient underwent echographic examination because of the outbreak of a unilateral relapsed ocular hypertensive attack that required an ultrasound biomicroscopy (UBM) to be accurately diagnosed and treated. RESULTS: The bilateral AAC regressed completely after pharmacologic therapy. UBM evaluation of the eye with recurrence of the angle-closure glaucoma attack was necessary to confirm the diagnosis of unilateral relapsed angle-closure glaucoma due to an unresolved pupillary block. A viscoelastic-aided opening of the angle and peripheral surgical iridectomy were performed. UBM and tonometry were performed intraoperatively to confirm the success of the surgical treatment. CONCLUSIONS: The UBM allowed us to identify the pupillary block as the main mechanism involved in the pathogenesis of this unusual case of simultaneous bilateral AAC glaucoma. Despite the fact that drug-induced supraciliary uveal effusion and mydriasis due to surgical anesthesia have been frequently reported to contribute to this complication, we presumed that simultaneous intravenous administration of sedative drugs and adrenergic agonists, in a patient with individual biometric predisposing factors to the angle-closure, created the anatomic conditions which induced the pupillary block with obliteration of the trabeculum.

Comparison of dynamic contour tonometry and goldmann applanation tonometry in deep lamellar and penetrating keratoplasties.

PURPOSE: To compare the measurements of intraocular pressure (IOP) with dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in eyes with corneal graft and to evaluate the influence of corneal thickness (CCT), corneal curvature (CC), and astigmatism on these methods. DESIGN: Prospective, observational cross-sectional study. METHODS: Eighteen eyes of 18 patients after penetrating keratoplasty (PKP) and 14 eyes of 14 patients after deep lamellar keratoplasty (DLKP) underwent IOP evaluation with DCT and GAT, and measurements of CCT, CC, and astigmatism. Bland-Altman plots were used to evaluate the agreement between tonometers. Multivariate regression analysis was used to evaluate the influence of ocular structural factors and running suture on IOP measurements obtained with both tonometers. RESULTS: IOP values obtained by DCT and GAT were strongly correlated in all eyes (r = .91; P < .001). DCT values measured 2.5 +/- 1.7 mm Hg higher than GAT readings (P < .001). A reduction of the mean IOP difference between DCT and GAT with an increase in IOP values (P < .001) was found. Regression analysis showed no effect of CCT, CC, astigmatism, and running suture on both DCT and GAT readings, either in DLKP or in PKP eyes. CONCLUSIONS: We found a good overall correlation between both tonometers but the agreement between instruments differs in high or low IOP ranges. The wide and varying 95% limits of agreement between DCT and GAT indicates that DCT provides IOP measurements on deep lamellar and penetrating keratoplasties which can be used in the clinical practice.