This is a case of a patient with rapidly progressive glaucoma who was successfully treated with cataract surgery with iStent inject implantation.
A 73 year old Caucasian lady presented to Mr Mohamed in April 2019 for a second opinion. She had noticed deterioration in her subjective vision in the right eye and had also noticed that she was experiencing pain around the right eye.
She had been under the care of another ophthalmology department since 2015. She had been told she had pigment dispersion syndrome. In January 2018, about a year prior to presentation to Mr Mohamed, her intraocular pressure had been increasing and she had been started on eye drops to lower the pressure.
By December 2018, she had noticed that the vision in her right eye had been deteriorating compared to her left eye. The field tests below show the rapid progression of visual field loss in her right eye over a relatively short time. She was told that this loss of vision was due to progressive pigmentary glaucoma. At this stage, she decided to seek help from Mr Mohamed.
The visual field charts below show the rapid loss of visual field in the right eye over 11 months. The white areas represent the field of vision which is seen and the darker areas represent loss of field of vision.
Mr Mohamed commenced further medical therapy but despite maximally tolerated medical therapy, her eye pressure remained uncontrolled. After appropriate discussion, the patient underwent cataract surgery with iStent inject implantation in May 2019.
The procedure was perfomed under local anaesthetic and took around half an hour. She used eye drops for 6 weeks after surgery and continued with a reduced number of eye drops for her glaucoma. This procedure improved her eye pressure and the field tests below show stabilisation of her disease over the following 9 months with no evidence of further loss of visual field.
This case highlights the benefits of careful treatment in preserving eyesight and preventing blindness in a patient with glaucoma.