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Glaucoma

A Case of Unilateral Intraocular Pressure Elevation in a Patient With Glaucoma

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Ophthalmology

Published Online: November 10, 2022

JAMA Ophthalmology Clinical Challenge

Article Information and Disclosures

Katia E. Chavez, MD, MPH¹;

Elizabeth A. Cretara, MD¹;

Rachel E. Davis, MD¹

Author Affiliations

¹Department of Ophthalmology and Visual Sciences, University of New Mexico Health Sciences Center, Albuquerque

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A 52-year-old man with a history of severe primary open-angle glaucoma in both eyes and elevated intraocular pressure (IOP) in response to topical corticosteroids presented with an IOP above target of 19 to 23 mm Hg OS. He also had mild chronic macular edema in both eyes after remote cataract surgery and vitrectomy with membrane peel in both eyes. Two years prior, he underwent Baerveldt tube shunt in his left eye, and his IOP since surgery had been 8 to 14 mm Hg. Ophthalmic medications on presentation were timolol eye drops twice daily, brinzolamide-brimonidine eye drops 3 times daily, bimatoprost eye drops every night at bedtime, bromfenac eye drops once daily, and fluorometholone eye drops twice daily in both eyes.

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A 52-year-old man with a history of severe primary open-angle glaucoma in both eyes and elevated intraocular pressure (IOP) in response to topical corticosteroids presented with an IOP above target of 19 to 23 mm Hg OS. He also had mild chronic macular edema in both eyes after remote cataract surgery and vitrectomy with membrane peel in both eyes. Two years prior, he underwent Baerveldt tube shunt in his left eye, and his IOP since surgery had been 8 to 14 mm Hg. Ophthalmic medications on presentation were timolol eye drops twice daily, brinzolamide-brimonidine eye drops 3 times daily, bimatoprost eye drops every night at bedtime, bromfenac eye drops once daily, and fluorometholone eye drops twice daily in both eyes.

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Article Information

Corresponding Author: Elizabeth A. Cretara, MD, Department of Ophthalmology and Visual Sciences, University of New Mexico Health Sciences Center, 1600 University Blvd NE, Albuquerque, NM 87102 (ecretara@salud.unm.edu).

Published Online: November 10, 2022. doi:10.1001/jamaophthalmol.2022.4735

Conflict of Interest Disclosures: None reported.

References

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Bozić M , Hentova Senćanin P , Branković A , Marjanović I , Dordević Jocić J , Senćanin I . Effect of a tight necktie on intraocular pressure. Article in Serbian. Med Pregl. 2012;65(1-2):13-17. doi:10.2298/MPNS1202013B PubMed Google Scholar Crossref

LeMarr JD , Golding LA , Adler JG . Intraocular pressure response to inversion. Am J Optom Physiol Opt. 1984;61(11):679-682. doi:10.1097/00006324-198411000-00005 PubMed Google Scholar Crossref

Ho YJ , Yeh CH , Lai CC , Huang JCC , Chuang LH . ExPRESS miniature glaucoma shunt for intractable secondary glaucoma in superior vena cava syndrome—a case report. BMC Ophthalmol. 2016;16:125. doi:10.1186/s12886-016-0301-6 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.