Table of Contents - WOC 2012

WOC2012 Abstract Book
PO-GLA-84
Pigmentary Glaucoma Accompanied by MarfanSyndrome with
Fluctuating IOP
Chakravarti Tutul (1)
1. Eye and Glaucoma Care
This presentation reports a case of pigmentary glaucoma (PG) accompanied
by Marfan syndrome with bilateral ectopialentisand fluctuatingIOP. Little has
previously been described in the ophthalmic literature regardingthe relationship
between Marfan syndrome and PG. Though a case report onMarfan syndrome
with bilateral PDS and an asymmetrical PG case were reported, symmetrical
glaucoma progression in a PG accompanied by Marfansyndrome with bilateral
lens subluxation was not reported before. 22-year tall, slender person presented
with the following findings on: best corrected vision 6/6 and 6/12 with -5.00
Dsph in his right and left eye respectively, bilateral deep AC, (Anterior chamber
average: 4.10 and 4.17 in right and left eye respectively), bilateralKrukenberg
spindle, and patent YAG iridotomies in both eyes. Gonioscopic findings:
angles were widely open, with a homogeneous, dense hyperpigmented band
on the trabecular meshwork. Pigment also deposited on schwalbe›s line.
Pigmented line on posterior lens capsule (Zentmayer line) at the insertion of
zonulein both eyes was present. Both eyes presentedwith almost symmetrical
upward subluxation of lens on dilation. On fundus examination he presented
with advanced glaucomatous cupping in both eyes. His visual field showed
(10-2, Humphrey, Automated perimetry) advanced field loss.He was seen on
different times of the day to record his dinural variation. It was seen that his
IOP fluctuation did not follow any pattern (morning or evening). But fluctuations
happened in both of his eyes with similar kind of treatment from 10 to 30 mm of
Hg in and 14 to 30 mm of Hg in his right and left eye respectively. His IOP came
to lower teens with oral acetazolamide and topical three medications. He was
last seen on 14th June, while his IOP was 14 mm of Hg in both eyes with three
topical medications and with oral sustain releaseacetazolamide (250 mg) once
a day. His cardiologist diagnosed him as a caseof Marfan Syndrome with the
following findings: tall with some arachnodactyly; arm span more than height;
high arched palate, bilateral lenticular subluxation, mild aortic regurgitation
and with mildly dilated aortic roots (BP 120/76 mm of Hg, pulse 76). He was
diagnosed with pigmentary glaucoma accompanied with Marfan syndrome. He
was unable to tolerate 1% pilocarpine. He was advised to follow up after 3
months and review for further treatment option. Pigment Dispersion syndrome
is bilateral disorder and asymmetric involvement is commonly seen. Bilateral
advanced glaucoma in this case is explained by the dual mechanism: 1)
anomaly ofthe anterior chamber angle due to presence of PDS and 2) bilateral
ectopialentis. Huge IOP variation can be explained by the mechanical factor
of lens subluxation in both eyes that might affect the iridozonular contact in
both eyes in a variable way. The report purports1) to draw attention to a very
unusual case; 2) symmetrical nature of progression of apigmentary glaucoma
even in the presence of a second disorder, like ectopialentis;and 3) huge Intra
Ocular pressure fluctuation (even in a short period of time). Such association
(thoughrare)should be borne in mind to make a timely diagnosis and treatment
possible.
PO-GLA-85
Does Ultrasonic Bio-microscopy(UBM) help in determining cause of
failure to control Intra-ocular Pressure after placement of Anterior
Chamber(AC) Shunt
Nath Sanjeev (1,2) , Sherman Jerome (1,3) , Hosssain Sheikh M (1) , Sharma Vishal
(1) (1)
, Mendonca Roni
1. Eye Institute and Laser Center
2. New York Eye and Ear Infirmary
3. Suny College of Optometry
Purpose: To dertermine if UBM provides useful information for management of
elevated intraocular pressure after placement of glaucoma shunts in the
anterior chamber.
Methods: 22 eyes not reaching target pressures after shunt placement were
evaluated with linear scanning UBM. Tube postion,obstruction,extraocular
sdarring and bleb anatomy were all analysed. 4 eyse had tube obstruction
after chamber shallowing post-op. 3 eyes had shallow serous choroidals. 3 eye
had shunt malposition and remaining eyes had extra-ocular scarring/encysted
blebs.
Conclusion: UBM is a usefull instrument to assist in management of failur of
IOP control after shunt placement
536
PO-GLA-86
PREFERRED MODE OF TREATMENT FOR PSEUDOEXFOLIATION
GLAUCOMA- A CLINICAL STUDY
Sodimalla Kalyani Vijaya Kumari, Deshpande Madan, Chelerkar Vidya
Purpose: To study the preferred mode of treatment for pseudoexfoliation
glaucoma. Materials and
Methods: Retrospective analysis of PXF glaucoma management at a tertiary
care centre. Medical history and BCVA were noted, IOP, gonioscopy, slit lamp
examination and disc evaluation were done pre and post treatment.
Results: 71 patients were in age group 60-80 years, 69% were males and 31%
were females. CD ratio was 0.9 in 39% and 0.6-0.8 in 33.8% patients. 49%
patients have IOP 25-40 mm Hg. 12.6% has 51-60mm Hg. Post surgery IOP
was 12-18mm Hg in 82% patients. Rest needed additional single drug. Patients
under medical treatment needed 2-3 drugs for the target IOP to achieve. With
medical therapy patient needed 2-3 drugs which is costly affair and poor
compliance. 24 hour uniform maintains of IOP is not possible
Conclusion: In contrast to medical therapy, surgical treatment for
Pseudoexfoliation glaucoma gives better control of IOP, and maintains uniformly
throughout the day, hence, further ONH damage and field progression is better
controlled.
Immunology, Molecular Biology and Microbiology
PO-IMM-01
Screen for Small Molecule Regulators of Retinal Pigmented Epithelial
Cell Phagocytosis
Elliott Jimmy (1) , Cho Charles (1)
1. Genomics Institute of the Novartis Research Foundation (GNF)
Objective/Purpose Retinitis Pigmentosa (RP) is a genetic disease leading to
blindness. Several mutations have been found to cause RP, some of
them inducing a defect in the retinal pigment epithelium (RPE). The RPE
phagocytizes photoreceptor outer segment (POS) membranes as part of the
normal ongoing process of POS renewal. Mutations in C-mer proto-oncogene
tyrosine kinase (MERTK), have been associated with disruption of the RPE
phagocytosis pathway and autosomal recessive RP in humans. MERTK
protein is involved in the ingestion step of POS phagocytosis since primary
dystrophic RPE cells isolated from RCS rat display a dramatic reduction of POS
phagocytosis. Methods We developed of an assay to find small molecules that
rescue phagocytic function in a cellular model of MERTK loss-of-function. This
assay has been miniaturized and successfully quantitated using high content
imaging. Results A collection of small compound library have been screened
and we identified novel regulators of RPE POS phagocytosis. Conclusion
Compounds identified by this screening method can serve as chemical probes
for positive regulation of phagocytosis as well as provide a starting point for the
development of novel neuroprotective drugs