First Author: J.M.Sandoval Codoni SPAIN
Co Author(s): J.M. Sandoval Codoni A. Soler García J. Mora Castilla R. Luque Aranda 0 0 0 0 0 0 0 0 0
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Schwartz-Matsuo syndrome shows combined signs of aqueous cells and high intraocular pressure secondary to rhegmatogenous retinal detachment. Aqueous cells disappear after surgical reattachment of the retina, leading to normalization of the intraocular pressure.Previous intraocular surgery or blunt ocular trauma sometimes underlie the syndrome, leading to midperipheral tears The elevated intraocular pressure is usually discovered incidentally at the time of diagnosis of the retinal detachment, and resolves without specific treatment when the retina is reattached. We present a case in which the reverse was found. The patient presented with acute glaucoma and the retinal detachment was found incidentally.
Department of Ophthalmology, HCU Virgen de la Victoria, Málaga, Spain
A 51-year-old man visited the emergency room due to a 12 hours history of pain in the left eye and blurred vision, following 3 days of photopsias and myodesopsias in that eye. He reported a medical history of arterial hypertension treated with enalapril, the ophthalmological history, refractive surgery with LASIK 6 years before and cataract surgery in the left eye 2 years before . Corrected visual acuity was 20/20 right eye and hand motion left eye. The left eye showed mild conjunctival injection, with moderate epithelial oedema of the cornea, cells in the anterior chamber, and intraocular pressures of 45 mm Hg left eye and 18 mm Hg right eye (applanation). Pseudoaphakic. Funduscopy showed a mild hemovitreous and a superior retinal detachment. Neither the drainage angle nor the peripheral retina of the left eye could be seen at this time because of the corneal oedema. The right eye was normal with open angle on gonioscopy. Treatment started with oral acetazolamide, betamethasone, timolol and brimonidine eyedrops. The following morning the pain had settled and intraocular pressure was 19 mm Hg in the left eye. The cornea was clear and gonioscopy revealed an open angle. Anterior chamber cells were less frequent.
A 23G vitrectomy was performed using perfluoropropane as tamponade, Following surgery the intraocular pressure returned to normal within 48 hours, with gradual clearing of cells from the anterior chamber. All topical and systemic medications were discontinued within 2 weeks with no further increase in intraocular pressure or recurrence of aqueous cells. A macular hole appeared and required treatment.
Our case has enough features to allow the diagnosis of Schwartz–Matsuo syndrome: male with a history of cataract surgery, presenting with symptoms of acutely raised intraocular pressure, ‘cells’ in the anterior chamber, and a retinal detachment found subsequently. It is not common in the literature that acute glaucoma is the reason for consultation in this pathology We believe, therefore, that the Schwartz–Matsuo syndrome should be considered in the differential diagnosis of acute open angle glaucoma, especially if occurring in a pseudofakic patient