First Author: M.Figurska POLAND
Co Author(s): K. Krix-Jachym A. Siemiątkowska J. Wierzbowska M. Rękas 0 0 0 0 0 0 0 0 0
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To present a case of uveal effusion, serous retinal detachment and acute angle closure glaucoma in patient with deterioration of renal function, treated with furosemidum. In anamnesis the history of acute renal failure 3 months earlier as well as overlap syndrome (coexisting primary Sjogren’s Syndrome and rheumatoid arthritis) together with non-specific inflammatory bowel disease was demonstrated. On the basis of presented case consideration of possible causes of uveal effusion with coexisting subretinal fluid and secondary acute angle closure glaucoma was performed together with analysis of treatment method and presentation of imaging examinations.
Department of Ophthalmology, Military Health Service Institute in Warsaw
Interventional case report, three months follwow up. The patient was diagnosed and treated because of choroidal effusion, elevated IOP and blurred vision of the right eye and angle closure in the both eyes. Moreover central serous retinal detachment was observed in both eyes. Collected data included BCVA, IOP, gonioscopy and anterior and posterior segment examination. The fluorescein angiography, ultrasound examination and OCT was performed in both eyes.
A 57-year-old woman with primary Sjogren’s Syndrome, rheumatoid arthritis and inflammatory bowel disease with generalized oedema presented with onset of acute pain, blurred vision in her right eye and conjunctival oedema in the both eyes. Upon examination on the first day the patient’s BCVA was 1,0 in both eyes. The IOP was 30 mm Hg in the right eye and 16 mm Hg in the left eye. A slit-lamp examination showed shallow anterior chambers in both eyes. Gonioscopy showed 360° of appositional angle closure with a convex iris configuration in the right eye, narrow angle with convex iris in the left eye. During observation BCVA worsened and myopic shift was observed. In the fundus examination foveal subretinal fluid was established and ultrasonography revealed choroidal effusion in the right eye. The patient was treated with topical dorzolamid and dexamethasone. After a week BCVA returned to 1,0 in both eyes and myopic shift resolved. The IOP normalized after 2 days of treatment. After 5 days the anterior chamber deepened, the angles were opened in both eyes and after one week of treatment choroidal effusion had resolved in the right eye. Serous retinal detachment resolved almost completely during lasting three months observation.
Deterioration of renal function and furosemidum use may be associated with choroidal effusion and presence of serous retinal detachment together with iris-lens diaphragm anterior movement causing acute angle closure glaucoma (ACG). Expansion of the extravascular compartment, due perhaps to a sudden breakdown of the blood-ocular barrier to large proteins could occur in this case caused by systemic disease and resulted in choroidal effusion and serous retinal detachment. Increase of choroidal volume may lead to shallowing of the anterior chamber and the rise of IOP. OCT examination, the fluorescein angiography, ultrasound examination are helpful in diagnosis and establish of treatment in such cases.