Primary Angle Closure Glaucoma

Goniophotos of the right eye

1. Nasal angle
2. Inferior angle
3. Temporal angle
4. Superior angle

Goniophotos show the anterior trabecular meshwork visible in parts of the nasal image (1) but otherwise no structures are visible. No synechiae are visible.

Anterior OCT images (right eye)

1. Temporal angle
2. Superior angle
3. Nasal angle
4. Inferior angle

Anterior OCT images show a steep iris profile and narrow angles. There is possible iridocorneal contact in the temporal angle (image 1).

Pentacam Anterior Chamber Depth

Pentacam topography shows a shallow central anterior chamber depth of 1.66mm.

Disc photo (right eye)

The disc photo shows a healthy looking neuro-retinal rim.

Cirrus RNFL Analysis

There is a relative reduction in RNFL thickness in the right eye (as compared with the left) both superiorly and inferiorly on the TSNIT curve. The RNFL clock hours show a significant thickness difference between the eyes supero-temporally and infero-temporally, although the measurements still lie within the normative distribution

Cirrus Ganglion Cell Analysis (GCA)

GCA shows no significant pattern of thinning in either eye.

24-2 SITA-Standard Visual field Analysis

Field results show a possible superior arcuate loss with a less convincing inferior loss. These areas of reduction in sensitivity suggest possible concordance with the structural changes seen on OCT however further investigations are required to confirm. A diagnosis of primary angle closure is suggested by the findings at this point, and prompt referral to an ophthalmologist was arranged to examine for glaucomatous optic neuropathy also.

Fundus photography (right and left eye)

Fundus photos show average sized discs in each eye. Thinning of the neuroretinal rim is evident in the right eye both superiorly and inferiorly.

Red-free images (right and left eye)

The red-free image of the right eye shows reduced RNFL reflectivity, especially inferiorly.

Stereoscopic disc photo (right eye)

Please use a stereoviewer or 15 prism dioptres base out to view this image.

Stereophotos show significant cupping in the right eye and a thin superior and inferior neuroretinal rim. The lamina cribosa pores are visible.

Stereoscopic disc photo (left eye)

Please use a stereoviewer or 15 prism dioptres base out to view this image.

Stereophotos show a healthy neuroretinal rim in the left eye with moderate cupping.

Cirrus RNFL analysis

The RNFL thickness and deviation maps show significant RNFL loss in the right eye. whilst the left RNFL remained within normative limits.

Cirrus Ganglion Cell Analysis

The GCA indicates generalised GCIPL reduction in the right eye, but remained within normal in the left eye.

24-2 SITA-Standard visual field analysis

The 24-2 shows an inferior arcuate defect in the right eye and a possible superonasal step. These were repeatable on subsequent testing. The left visual field is unremarkable.

The diagnosis was primary angle closure glaucoma in the right eye and this patient was treated immediately with pilocarpine and apraclonidine under the supervision of the CFEH consultant ophthalmologist with IOP measurements taken every 30 minutes for 3 hours. At this time the right IOP was 20mmHg and this had reduced further to 11mmHg by the following morning.

Goniophoto (inferior angle, left eye)

The goniophoto shows peripheral anterior synechiae in the inferior angle. This finding is likely associated with the history of previous trauma which was further elicited from the patient's history.

Pentacam Anterior Chamber Depth (right and left eye)

Pentacam shows the central anterior chamber depth to be 2.28mm and 2.34mm in the right and left eyes respectively .

Disc photos (right and left eye)

Disc photos show a healthy neuroretinal rim in the left eye and possible thinning superiorly in the right eye

Fundus photographs (right and left eye)

Fundus photography shows average sized discs in each eye. The neuroretinal rim appears healthy in the left eye, and there is possible superior thinning in the right eye

Red-free images (right and left eye)

The RNFL appears healthy in the left. There is a slight reduction in RNFL reflectivity in the right eye superiorly corresponding to the thin neuroretinal rim.

CIrrus RNFL analysis

RNFL analysis revealed slight asymmetry between the two eyes, with the right superior RNFL bundle being thinner compared to the left.

Cirrus Ganglion Cell Analysis (GCA)

GCA results were unremarkable.

24-2 SITA-Standard Visual Field

24-2 shows inferior depressions in the right eye which may correspond to the structural findings however, test reliabliity was low. The results for the left eye show no significant defects.

These findings are suggestive of PACS in both eyes with suspicion of glaucomatous damage in the right eye. As a result, this patient was referred to a glaucoma specialist for treatment of the angle presentation.