Sight threatening acute angle - closure glaucoma
Introduction. Acute angle-closure glaucoma is an ophthalmic emergency that occurs due to sudden closure of the angle of the anterior chamber of the eye, causing an abrupt intraocular pressure (IOP)increase that can lead to blindness, if untreated. Treatment of acute angle closure is very important as long standing angle closure attack impairs visual function and further surgical treatment is necessary to manage the case. Case Description. 72 year-old female presented to the Department of Ophthalmology with painful left eye and decreased vision for 1 month. 1 month ago she was presented to the Emergency Room (ER) with acute glaucoma attack of the left eye and IOP of 40,6. In the ER intravenous osmotic diuretic was administered (Manitol), IOP decreased to 22,4 mmHg and patient was discharged with topical Brinzolamide and Timolol twice a day. She suffered from mild ocular pain and decreased vision for 1month. After 1 month during examination visual acuity was 0.1, IOP 50.6, red eye, hazy cornea, shallow anterior chamber, mid-dilated pupil, cataract (glaucomflecken), pale optic disk. With intravenous osmotic diuretics (Manitol) and topical antihypertensive treatment IOP remained high (>40 mmHg). Lens extraction with IOL implantation and pars plana vitrectomy (PPV) was performed, after the surgery during the follow up visual acuity was 0.4 and IOP decreased to 9 mmHg. Prophylactic peripheral iridectomy (PI) of the right eye was performed. Summary. This clinical case presents the importance of adequate treatment of acute angle closure attack with decreasing IOP and performing PI as if not sufficiently treated the case later requires surgical treatment with lens extraction and PPV and standing high IOP leads to loss of visual function. Conclusions. Adequate and timely treatment of angle-closure glaucoma is very important in preserving patients visual function.