Ganesh Raman

Mefenamic acid-induced bilateral transient myopia, secondary angle closure glaucoma and choroidal detachment

Drug-induced secondary angle closure is quite common and in the majority of cases simply stopping the medication leads to rapid reversal of the condition and resolution of glaucoma. We describe here a patient who presented with secondary angle closure glaucoma and myopia following mefenamic acid ingestion which was managed successfully by stopping the medication, symptomatic treatment and reassurance.

Evaluation of Angle Closure as a Risk Factor for Reduced Corneal Endothelial Cell Density

Purpose: Acute angle closure attacks are frequently accompanied by corneal edema. However, little is known about corneal endothelial cell status at different stages of angle closure. Here, we compared endothelial cell density (ECD) in unoperated eyes with that in eyes with open angles (OAs) and various stages of angle closure disease. Materials and Methods: The study was conducted at Aravind Eye Hospitals in India. Masked examiners performed gonioscopy to classify each eye as follows: (1) OA, (2) primary angle closure suspect, or (3) primary angle closure (PAC)/primary angle closure glaucoma (PACG). Specular microscopy was performed and differences in ECD were analyzed using hierarchical models. Results: A total of 407 patients and 814 eyes were studied, including 127 (15.6%), 466 (57.3%), and 221 (27.1%) with PAC/PACG, primary angle closure suspect, and OA, respectively. Participants were predominantly female (69.8%) and the mean age was 49.2 (SD: 8.6) years. Lower ECD was observed with increasing age [&bgr;=−6.3 cells/mm2; 95% confidence interval (CI), −9.3 to −3.3, per year; P<0.001], greater iridotrabecular contact [&bgr;=−15.6 cells/mm2; 95% CI, −28.3 to −2.9, per quadrant of contact; P=0.016), and shallow (<2.5 mm) anterior chamber depth (&bgr;=−40 cells/mm2; compared to deeper ACs (≥2.5 mm), 95% CI, 78.9-1.1; P=0.044). In age-adjusted analyses, angle closure suspects had lower ECD than OA eyes (&bgr;=−54.7 cells/mm2; 95% CI, −47.8 to −85.3; P=0.018), although PAC/PACG eyes were not significantly different from OA eyes (&bgr;=−18.6 cells/mm2; 95% CI, −85.9 to 2.5; P=0.058). Conclusion: In untreated eyes, only mild, clinically insignificant decrement in ECD was noted with angle closure.

Angle Closure Phenotypes in Siblings of Patients at Different Stages of Angle Closure

Financial Disclosures: The authors made the following disclosures: M.Y.K.: Consultant e Alcon, Allergan, Aerie Pharmaceuticals, Forsight Vision 5, and Tempest Ocular; Other e Alcon, Allergan, Aerie Pharmaceuticals, Forsight Vision 5, Tempest Ocular; Grants e Alcon, Allergan, Clarvista Medical, New World Medical, AMO, Glaukos, Aerie Pharmaceuticals, outside the submitted work; Patent e Clarvista, Glaukos, AMO, Shapetech; Grant funding NEI. P.Y.R.: Grants e National Eye Institute, Research to Prevent Blindness, outside the submitted work. L.K.S.: Other e Allergan, Sensimed, New World Medical; Grants e Alcon, outside the submitted work. J.R.S.: Grants e Alcon, Allergan, Bausch & Lomb, Glaukos, Regeneron, outside the submitted work. Supported by the Slater Family Endowment (M.Y.K.). The sponsor or funding organization had no role in the design or conduct of this research.

An unusual presentation of Pseudomonas aeruginosa blebitis following combined surgery

We report a case of blebitis that occurred 3 years later following a combined glaucoma and cataract surgery. It was an atypical presentation, as patient had no classical fiery looking signs of blebitis despite the isolated organism being Pseudomonas aeruginosa. Improvized surgical techniques like use of Mitomycin C, releasable flap sutures though considered as part of the recommended procedure for better surgical outcomes, their role as potential risk factors for visually blinding complications like endophthalmitis are often overlooked. This case report throws light on such risk factors for bleb associated infections and recommends removal or trimming of all releasable sutures and the need for a regular postoperative follow-up.

Bilateral idiopathic spontaneous filtering bleb with ectopia lentis: A case report and review of literature

A 26-year-old male presented with superior filtering bleb with scleral thinning, dislocated lens, and hypotony in both the eyes. His cornea was normal without any sign of ectasia, and there was no history of recurrent redness, trauma, or surgery in either eye. Anterior segment optical coherence tomography did not reveal communicating fistula between the anterior chamber and subconjunctival space. Physical examination and blood investigations did not reveal any systemic association. He was diagnosed to have spontaneous filtering bleb, which is a rare condition observed with ocular or systemic abnormalities.