ABSTRACT
BACKGROUND: We present a long term follow-up of a young female patient with choroidal infarction, primary open angle glaucoma and Flammer syndrome. The patient had no classical risk factors for vascular occlusions, except for the presence of Flammer syndrome. The essential feature of this syndrome is primary vascular dysregulation, sometimes including vasospasm. The vessels of affected people respond more intensely to a number of stimuli, such as coldness or emotional stress. Any organ can be involved, including parts of the eye. The dense autonomic innervation of the choroidal vessels predisposes them particularly to vasospasms. CASE PRESENTATION: The patient was originally referred to our centre because of a deep unilateral paracentral scotoma with the presumptive diagnosis of a normal tension glaucoma. The discrepancy between the visual field defect and the optic nerve head morphology, however, led us to a vascular evaluation by a simultaneous fluorescein/indocyanine green angiography. This revealed an antecedent choroidal infarction that explained the visual field scotoma and the retinal nerve fibre layer defect in the corresponding area. During the follow-up period of 11 years, the patient also developed bilateral glaucomatous optic neuropathy despite a well-controlled intraocular pressure. CONCLUSIONS: We hypothesise that in the patient presented here, the Flammer syndrome contributed to both the acute unilateral choroidal infarction and to the chronic development of bilateral glaucomatous optic neuropathy.
Subject(s)
Choroid Diseases/etiology , Choroid/blood supply , Infarction/etiology , Low Tension Glaucoma/complications , Retinal Diseases/complications , Adult , Choroid Diseases/diagnosis , Female , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Humans , Infarction/diagnosis , Low Tension Glaucoma/diagnosis , Retinal Diseases/diagnosis , Syndrome , Time FactorsABSTRACT
INTRODUCTION: Selective laser trabeculoplasty (SLT) is applied to reduce intraocular pressure in primary open angle glaucoma therapy. It selectively subjects trabecular pigmented cells to a pulsed, frequency-doubled Nd:YAG laser. The biostimulatory effect on trabecular macrophages was also postulated even in low-pigmented angles. The aim of the study was to assess the hypotensive effectiveness of SLT depending on the degree of iridocorneal angle pigmentation. MATERIAL AND METHODS: Sixty-three eyes of 53 patients with primary open angle glaucoma (POAG) were included in this study and than divided into three subgroups, dependind of iridocorneal angle pigmentation. All subjects underwent SLT on 270 degrees of the angle. Intraocular pressure (IOP) was assesed at baseline and 6 weeks after the laser procedure. RESULTS: Six weeks post-SLT mean IOP reduction was 2.63 mm Hg. The degree of IOP reduction showed a significant correlation with angle pigmentation. Intraocular pressure fell by 2.06 mm Hg, 2.46 mm Hg and 4.75 mm Hg in subgroups with low, marked and high pigmentation, respectively. CONCLUSIONS: The SLT procedure most effectively reduces IOP only in the subgroup of POAG patients with marked angle pigmentation and it is equal to clinically succesfull hypontesive therapeutic effect, according to European Glaucoma Society guidelines. However, lower hypotensive effect in other study subjects may also be the valuable addition to pharmacological therapy of glaucoma.
