Imaging Review of Case Studies

Review of Clinical Case Studies

By Robert J. Noecker, MD, MBA

Case 1: Monitoring Progression

• 60-year-old professor referred for glaucoma
• Glaucomatous changes in left eye and suspicious changes in right eye
• Visual acuity 20/20 in both eyes
• Pachymetry 541/562
• IOP 20 mmHg right and 22 mmHg left baseline
• Treated left eye with travoprost with reduction of IOP to 15 mm Hg; right eye observed
• Followed with OCT and visual fields
• Left eye stable over several years
• Right eye demonstrated changes on OCT and visual field
• Therapy advanced to travoprost OU
• IOP reduced to 14-15 mmHg on monotherapy with travoprost

Case 2: Stabilizing IOP

• 62-year-old woman with a macular hole in the right eye and glaucoma in the left eye
• Visual acuity 20/200 right and 20/25 left
• Baseline IOP 22-24 mmHg left eye
• Treated with latanoprost qd and timolol bid in left eye
• IOPs ranged in upper teens over several years
• Visual field showed early changes
• Express Glaucoma Filtration Device (Alcon) procedure performed
• IOP stabilized at 10 mmHg in left eye without medications
• Follow-up testing demonstrated stable pressure

Case 3: Multiple Surgical Interventions

• 57-year-old man with traumatic glaucoma in left eye, had been stable for many years on travoprost
• Right eye followed as ocular hypertensive for several years on travoprost
• IOP low 20s mmHg right eye (baseline upper 20s to low 30s)
• Left eye pressure had previous trabeculectomy that failed, and IOP began to increase rapidly to 40s mmHg despite multiple medications
• Patient went on to have glaucoma drainage devices, cataract surgery procedures with subsequent CME in the left eye
• IOP began to rise to upper 20s mmHg in right eye, which was unresponsive to the addition of dorzolamide and timolol combination and brimonidine
• Evidence of progression confirmed with follow-up OCT imaging
• Nuclear sclerotic cataract developed as well
• Surgical intervention with the Express device performed with simultaneous cataract removal in the right eye under topical anesthesia
• Patient tolerated surgery well with post-op Day 1 visual acuity of 20/25 and IOP 10 mmHg
• Patient maintained 20/20 vision and IOP 9-11 mmHg without drops