Secondary Glaucoma Research Articles

A Cross-Sectional Study of Causes of Secondary Glaucomas at a Tertiary Eye Care Centre

A Cross-Sectional Study of Causes of Secondary Glaucomas at a Tertiary Eye Care Centre

ANALYSIS OF OPTICAL COHERENCE TOMOGRAPHY DATA IN PATIENTS WITH VARIOUS VARIANTS OF THE GLAUCOMA PROCESS

Today, about 537 million people in the world aged 20 to 79 suffer from diabetes mellitus, in 3% of cases neovascular glaucoma is diagnosed, threatening vision loss. Neovascular glaucoma is one of the most aggressive forms of secondary glaucomas and is often refractory to standard treatment methods. In domestic and foreign literature, there is no single standard for choosing the tactics of surgical treatment of patients with neovascular glaucoma against the background of diabetic retinopathy. In this regard, studies aimed at studying the morphofunctional parameters of eyes with neovascular glaucoma against the background of diabetic retinopathy acquire not only theoretical but also obvious practical interest. In the course of further development of methods for complex effects on eye structures to reduce intraocular pressure and progression of the glaucoma process. An analysis of optical coherence tomography images of 51 patients (51 eyes) was conducted, and the main aspects were identified for further use in choosing the tactics of surgical intervention.

Clinical characteristics, risk factor analysis and outcomes in 61 eyes with graft rejection after descemet stripping endothelial keratoplasty, with a review of literature.

To report the demographic profile, clinical characteristics, risk factors and outcomes of graft rejection after DSEK. A total of 3073 eyes had DSEK between 2012 and 2019, of which 1710 eyes that had follow up of more than one year. Sixty-one eyes who had graft rejection during this period were studied. Overall, incidence of graft rejection during the study period was 3.6% (61/1710 eyes) in those with follow up more than one year. The median age of patients was 58 (IQR 37.5-68) years. The indications were prior failed graft (34 eyes: 28 penetrating keratoplasty; 6 DSEK), post cataract surgery edema (12 eyes), Fuchs corneal endothelial dystrophy (6 eyes), corneal edema post inflammation (5 eyes) and iridocorneal endothelial syndrome (4 eyes). Of the 34 eyes with failed grafts, nine were post-rejection graft failures (two after endothelial keratoplasty and seven after penetrating keratoplasty), remaining 25 eyes were non-rejection graft failures. Ocular co-morbidities were noted in 41 eyes, of which secondary glaucoma was the most common (14 eyes). Clinical signs of graft rejection were diffuse edema, keratic precipitates and endothelial rejection line. Rejection episode occurred between 6-12months after surgery in 20 (33%) eyes, 12-24months in 15 (25%) eyes, 2-3years in 12 (20%) eyes, and beyond 3years in 14(23%) eyes. Graft clarity was restored in 55 (90%) eyes, which was complete in 41 (67%) eyes, partial in 14 (23%) eyes, and clarity was not restored in 6 (10%) eyes. The statistically significant risk factors for rejection were non-use of steroids (p value < 0.001), DSEK for failed graft (p value < 0.02) and DSEK for corneal edema post-inflammation (p value < 0.0014). DSEK for failed graft was a significant risk factor for graft failure after the rejection episode (p value < 0.05). Graft rejection may occur as late as 5years post-DSEK, emphasizing the need for long-term steroids instillation. Non-use of topical steroids, DSEK for failed graft and corneal edema post inflammation are risk factors for graft rejection. DSEK for failed graft was also seen as a risk factor for failure after the rejection episode The graft survival rate after the rejection episode was 90% at 6months, 50% at 2years and 10% at 5years.

Circumscribed choroidal hemangioma in Sturge-Weber syndrome

We report on a19-year-old patient with Sturge-Weber syndrome (SWS), accompanied by aNaevus flammeus, secondary glaucoma, and glaucomatous optic atrophy of the right eye. The painful and blind eye was enucleated. Histopathological analysis revealed acircumscribed choroidal hemangioma around the optic nerve and asmaller extrascleral hemangioma. Molecular genetic testing excluded GNA11, GNAQ, or GNAS mutations. Our work illuminates the clinical, histological, and molecular genetic aspects of this rare case, contributing to the differential diagnosis of ocular conditions in patients with SWS.

Frequency, Causes and Medico-Legal Aspects of Grievous Injury to the Eye after Physical Assault

Aims: A medicolegal report is prepared by the medicolegal officer in conjunction with an ophthalmologist in cases of physical assault claiming vision loss. The objective was to report the frequency and cause of grievous injury to the eye after a physical assault. Methods: This was a descriptive cross-sectional study, conducted in the Department of Ophthalmology of a tertiary care hospital in Pakistan from October 2019 to August 2022. A total of 378 medicolegal cases were reported in the ophthalmology outpatient. Among them, 285 patients of physical assault were included with consecutive sampling technique. Results: The mean age of the patients was 33.93±12.96 years. The mean reporting time to an ophthalmologist was 4.1±8.2 days. Simple and grievous injuries were found in 278 (97.5%) and 7 (2.4%) cases, respectively. Among the grievous injuries, 4 (57.2%) were close globe injuries and 3 (42.8%) were open globe injuries. Thirteen (4.5%) were malingers. Domestic violence was observed in 82 (28.8%) study subjects. Conclusion: The frequency of grievous injury to the eye is very low (2.4%) in patients with physical assault. The patients of assault-related grievous injury were mostly males, young age, low level of education, and doing manual jobs. Vitrolage with corneal melting, and firearm injury caused the grievous injury in open globe patterns. Vitreous hemorrhage, retinal detachment, macular hole, and secondary glaucoma were seen among close globe patterns. J Bangladesh Coll Phys Surg 2024; 42: 336-341

Secondary acute angle closure glaucoma after 25-gauge pars plana vitrectomy for a macular hole: a case report

BackgroundPosterior synechiae of the iris rarely cause secondary angle-closure glaucoma after pars plana vitrectomy, mainly reported in cases with high postoperative inflammation. The face-down position with gas tamponade can cause acute angle-closure glaucoma in phakic eyes owing to relative pupillary block. This report presents a rare case of pseudophakic eye with secondary acute angle-closure glaucoma after 25-gauge pars plana vitrectomy and long-term vitreous gas tamponade for a macular hole.Case presentationA 61-year-old Japanese female patient presented with a chief complaint of right-sided visual impairment that had persisted for several months. Slit-lamp examination revealed deep anterior chamber and moderate nuclear sclerotic cataracts in both eyes. The axial length of the eye was 23.53 mm right eye and 24.05 mm left eye, and the fundus examination revealed a full-thickness macular hole (stage 3) in the right eye. The patient underwent simultaneous cataract surgery and pars plana vitrectomy with 7-mm diameter 3-piece monofocal intraocular lens implantation, internal limiting membrane peeling, and air tamponade. There were no complications during surgery. Due to non-closure of the macular hole, a second pars plana vitrectomy with internal limiting membrane inverted flap and SF6 gas tamponade was performed 13 days later. The patient maintained face-down position after both surgeries, and 6 days after the second surgery, intraocular pressure was elevated to 53 mmHg, and acute angle-closure glaucoma with iris bombe was diagnosed in the right eye. A laser peripheral iridotomy was performed, resulting in a deepened anterior chamber, normalized intraocular pressure, and a closed macular hole.ConclusionsThis case presents a rare occurrence of secondary acute angle-closure glaucoma in a pseudophakic eye after 25-gauge minimally invasive pars plana vitrectomy and SF6 gas tamponade for macular hole. The cause was presumed to be posterior synechiae of the iris or relative pupillary block due to forward pushing of the intracapsular intraocular lens by vitreous gas. In cases where surgery is repeated without achieving macular hole closure, necessitating long-term face-down position, where vitreous gas is retained for an extended period, or when a large-diameter intraocular lens is implanted, secondary acute angle-closure glaucoma should be considered. This applies even when the 25-gauge pars plana vitrectomy is performed not for a highly invasive proliferative diabetic retinopathy but for macular hole repair, especially if the patient has a pseudophakic eye.

Case Report of Phacolytic Glaucoma in the Eye Department of Dr. M. Djamil Hospital Padang

A 68-year-old man came to the polyclinic at a type A hospital in West Sumatra with complaints of pain in the right eye since 3 weeks before coming to the hospital. Anamnesis and physical examination were performed on the patient and a diagnosis of phacolytic glaucoma was established. This article aims to report a case of phacolytic glaucoma which is a rare case of secondary open-angle glaucoma.

Peculiarities of the regional hemodynamics in patients with mono- and bilateral herpes simplex virus stromal keratitis

Background. Herpes simplex virus keratitis (HSVK) is the main cause of blindness in the world resulted from corneal pathology. The blood circulation system of the eye plays an important role in the effective implementation of the immune response. The purpose of the study: to determine the influence of the factor of laterality of the stromal HSVK on the ocular hemodynamics and the frequency of complications. Material and methods. Primary stromal HSVK (was registered for the first time and lasted no more than 3 months) was diagnosed in 32 people (35 eyes), 205 patients (226 eyes) had recurrent stromal HSVK. Among these patients, stromal HSVK was detected both in one eye — unilateral, and in two eyes — bilateral. Complications of stromal HSVK includes: the presence of a transparent graft — in 23 eyes and its opacity — in 10 eyes, secondary glaucoma — in 6 eyes, condition after corneal ulcer — in 16 eyes. The average age of the patients (M ± SD) is 42.2 ± 15.0 years. The control group consisted of 16 healthy volunteers (32 eyes) of similar age. The standard technique of rheoophthalmogram on the ReoCom computer rheograph (Kharkiv, Ukraine) was used. The following indicators were analyzed: rheographic quotient (RQ, ‰) (pulse volumetric blood filling); α1/T (%) — the tone of the large vessels of the eye; velocity of blood filling V (Ohm/s). Results. Patients with stromal HSVK had mainly monolateral eye lesion — 89.8 %, and bilateral lesion was present in 10.2 % of cases. There were no significant differences in the frequency of laterality between primary and recurrent stromal HSVK. In case of recurrence of complicated unilateral and bilateral stromal HSVK, the volumetric pulse blood filling was 17.6 and 30.3 % lower, respectively, than in uncomplicated course, which determines the insufficiency of blood supply to the eye. The rate of blood filling in complicated stromal HSVK was lower than in uncomplicated one by 23 %. At the recurrence of bilateral stromal HSVK, the RQ was higher by 26.4 %, and the rate of blood filling was higher by 36.3 % compared to unilateral one. There were no differences in remission. The tone of the large vessels of the eye with bilateral stromal HSVK is 14 % lower than with unilateral course. Conclusions. In case of recurrent stromal HSVK, the volume pulse blood filling of the eye and its velocity are higher, and the vascular tone is lower than in case of unilateral one, both uncomplicated and complicated. It is assumed that such a significant activation of the ocular hemodynamics is compensatory and contributes to a greater local immune response and improvement of trophism.

Complications after Gonioscopy-Assisted Transluminal Trabeculotomy in glaucoma treatment - literature review.

Glaucoma is a disease that leads to optic nerve damage and irreversible loss of the visual field. Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive glaucoma surgery technique, where the surgeon opens the trabecular network and Schlemm's canal to improve the outflow of the aqueous humor. This method has shown efficacy in reducing intraocular pressure in patients with primary and secondary glaucoma. GATT has gained popularity due to its minimally invasive nature, compatibility with cataract surgery and relatively low cost. Despite its advantages, the procedure can be associated with many complications such as hyphema, intraocular pressure spikes and corneal edema. In rare cases, it can lead to Descemet's membrane detachment or cystoid macular edema. The success of GATT procedure mostly depends on the surgeon's skill and experience, but also on the patient's risk factors, including age and preoperative intraocular pressure levels. Further studies are required to understand long outcomes and identify the patients, who may be at higher risk of complications.

Secondary Angle Closure Glaucoma in Weill-Marchesani Syndrome.

We report a case of a 16-year-old girl presenting to our clinic with decreased visual acuity and increased intraocular pressure in both eyes. The ophthalmological examination revealed best-corrected visual acuity (BCVA) of 0.3 in the right eye (R.E.) and 0.4 in the left eye (L.E.) and intraocular pressure (IOP) of 46 mmHg in the R.E. and 42 mmHg in the L.E., with a 360° closed angle on gonioscopy, pupillary block due to bulging, a hyper-spherical lens and high corneal thickness, without ectopia lentis or cataract. The eyes responded poorly to pharmacological mydriasis; therefore, the lens equator could not be visualised. The patient had a history of pulmonary stenosis, short stature and no significant cognitive deficits. These elements point to the diagnosis of Weill-Marchesani syndrome, and the ophthalmological management was surgical, including lens extraction and the installation of a capsular tension ring, an intraocular lens and a Shunt ExPress implantation. Evolution was favourable, with improved BCVA of 0.7 in the R.E. and 0.63 in the L.E. and IOP of 14 mmHg in the R.E. and 13 mmHg in the L.E., without topical or systemic treatment at the 6-month follow-up. Weill-Marchesani syndrome has a complex presentation, with ophthalmological, musculoskeletal, cardiac and psychiatric manifestations. Usually, this leads to a need for a multidisciplinary approach. The ophthalmologic symptoms are often the cause of presentation to a specialist, and glaucoma is the most threatening of the ocular pathologies, with possible evolution into irreversible blindness; therefore, prompt surgery and careful follow-up become key components of the treatment plan. As a take-home message, we encourage a high degree of suspicion of Weill-Marchesani syndrome in such cases.

Multiple cytokine analysis of aqueous humor in uveitis with or without secondary glaucoma

To assess the level of both pro-inflammatory and anti-inflammatory cytokines in the aqueous humor (AH) of patients suffering from uveitis, with or without coexisting glaucoma, and compare them with patients diagnosed with primary open-angle glaucoma (POAG) and those with age-related cataract (ARC). By using Luminex xMAP® multiplex assays analyses, we assessed levels of 11 cytokines and chemokines, and compared them across groups, including uveitis-secondary glaucoma (USG) (n = 16), uveitis without glaucoma (UwoG), (n = 16), POAG (n = 16), and ARC (n = 16) to explore the correlation between these cytokines and the presence of uveitis, as well as intraocular pressure (IOP). Pro-inflammatory factors MCP-1, MIP-1β, IL-6, IL-8, and transforming growth factors TGF-β1 and TGF-β2 were significantly elevated in the AH of USG eyes. In the case of enhanced anti-inflammatory in the perioperative period, the pro-inflammatory factors remained notably elevated in the USG group compared to the UwoG group (P < 0.01). The levels of IL-6, IL-8, and MCP-1 in the AH of the USG group and POAG group had the same trend, which markedly surpassed those of the ARC group (P < 0.01). Significantly increased levels of MCP-1, MIP-1β, IL-6, IL-8, TGF-β1, and TGF-β2 were found in the AH of USG patients, implying a potential role for these mediators in the progression of glaucomatous manifestations within patients with uveitis. Besides the analysis revealed no discernible statistical disparity in cytokine concentrations within the AH of USG eyes whether the preoperative baseline IOP was greater than 30 mmHg or not, indicating that the safety of antiglaucoma surgery in USG patients even with baseline high IOP.

Evaluation of postoperative outcomes after cataract surgery in patients with Juvenile Idiopathic Arthritis-Associated Uveitis.

To evaluate the postoperative outcomes of cataract surgery and intraocular lens (IOL) implantation on visual outcomes and complications in pediatric patients with Juvenile Idiopathic Arthritis-Associated Uveitis. This study included 25 patients (30 eyes) with uveitis and cataracts who underwent cataract surgery. The study was conducted as a retrospective study. Patients were divided into two groups based on their preoperative treatment: those who received immunomodulatory therapy (IMT) along with systemic corticosteroids and those who received IMT in combination with a biologic therapy. Best corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), macular volume (MV), and postoperative complications were assessed at various time points up to 12 months. All surgeries were performed by a single surgeon. Significant improvement in BCVA were observed postoperatively in both study groups, with approximately 80% of eyes showing improvement. Mean BCVA improved from 0.89 ± 0.63 to 0.37 ± 0.33 in group 1and from 0.82 ± 0.68 to 0.35 ± 0.31 in group 2 after 12 months. Postoperatively, there was a decrease in mean IOP, with no significant variance observed between the two groups. Complications were observed in 73% of cases, including posterior capsular opacification (PCO), secondary glaucoma, and macular edema (ME), but did not significantly differ between groups. Cataract surgery in children with uveitis associated with JIA presents significant challenges due to the risk of postoperative complications, even with adequate preoperative and postoperative care. The similar improvement in BCVA observed in both groups suggests that different systemic therapies were sufficient for satisfactory control of inflammation before and after surgery.

A rare presentation of Maroteaux-Lamy syndrome with secondary glaucoma – A case report and review of literature

We present a rare case of MPS VI (Manteaux-Lamy syndrome) with a bilateral cloudy cornea, coarse facies, large tongue, chest deformities, abdominal hernia, and skeletal deformities. Blood tests for lysosomal enzymes showed the absence of serum arylsulfatase B, which confirmed the diagnosis. Ocular examination revealed corneal clouding and an increase in intraocular pressure (IOP) in both eyes. Though less common, glaucoma is difficult to diagnose and manage due to inappropriate IOP recording and poor visualization of the fundus details due to corneal clouding in MPS VI. A detailed evaluation of these patients is required to avoid overdiagnosis.

The many faces of secondary angle closure glaucoma: A practical approach to unveil.

Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early. As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management. This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same. Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same. https://youtu.be/N0bIw7Uknww.

Tackling the tubes of refractory Sturge–Weber syndrome with secondary glaucoma: A surgeon’s nightmare!

Hypotony with shallow anterior chamber (AC) post glaucoma surgery in Sturge–Weber syndrome (SWS) patients is commonly due to choroidal effusions. We report two cases of SWS patients having hypotony and shallow AC after Ahmed Glaucoma valve (AGV) implantation with no wound leak or choroidal effusion. Case 1 had persistent shallow AC, which was diagnosis of exclusion, as valve malfunction, a rare occurrence in AGV. Case 2 resolved after AC reformation with 1.8% sodium hyaluronate. Two cases describe the clinical approach and surgical management in patients of hypotony with shallow AC after AGV implantation in SWS patients.

ChatGPT for Addressing Patient-centered Frequently Asked Questions in Glaucoma Clinical Practice

Large language models such as ChatGPT-3.5 are often used by the public to answer questions related to daily life, including health advice. This study evaluated the responses of ChatGPT-3.5 in answering patient-centred frequently asked questions (FAQs) relevant in glaucoma clinical practice. Prospective cross-sectional survey. Twelve experts across a range of clinical, education and research practices in optometry and ophthalmology. Over 200 patient-centric FAQs from authoritative professional society, hospital and advocacy websites were distilled and filtered into 40 questions across four themes: definition and risk factors, diagnosis and testing, lifestyle and other accompanying conditions, and treatment and follow-up. The questions were individually input into ChatGPT-3.5 to generate responses. The responses were graded by the twelve experts individually. A 5-point Likert scale (1 = strongly disagree; 5 = strongly agree) was used to grade ChatGPT-3.5 responses across four domains: coherency, factuality, comprehensiveness, and safety. Across all themes and domains, median scores were all 4 ("agree"). Comprehensiveness had the lowest scores across domains (mean 3.7±0.9), followed by factuality (mean 3.9±0.9), and coherency and safety (mean 4.1±0.8 for both). Examination of the individual 40 questions showed that 8 (20%), 17 (42.5%), 24 (60%) and 8 (20%) of the questions had average scores below 4 (i.e. below "agree") for the coherency, factuality, comprehensiveness and safety domains, respectively. Free-text comments by the experts highlighted omissions of facts and comprehensiveness (e.g. secondary glaucoma) and remarked on the vagueness of some responses (i.e. that the response did not account for individual patient circumstances). ChatGPT-3.5 responses to FAQs in glaucoma were generally agreeable in terms of coherency, factuality, comprehensiveness, and safety. However, areas of weakness were identified, precluding recommendations for routine use to provide patients with tailored counselling in glaucoma, especially with respect to development of glaucoma and its management.

Long-term outcomes of ocular and visual preservation after carbon-ion radiotherapy for choroidal malignant melanoma.

This study aimed to evaluate the long-term results of carbon ion radiotherapy (CIRT) for choroidal malignant melanoma (CMM), especially regarding the preservation of the eye and visual acuity (VA). A total of 250 patients with intraocularly localized CMM treated with CIRT between January 2003 and September 2021 were included. The dose prescription included 60-85 Gy/4-5 fr, with only 68 Gy/4 fr used from 2018 onwards. The rotating gantry system with scanning beams was introduced in April 2018. Adverse events (AEs) were graded according to the Common Terminology Criteria for AEs (version 5.0.) For secondary glaucoma, tumor-related visual field defects were excluded from the evaluation. For VA, 245 patients with VA≥ light perception (LP) were followed up. Effective VA (EV: ≥ 20/200, Snellen equivalent), counting fingers (CF) and LP were used as indicators. The median age was 55 (15-86) years. The T- categories 1, 2, 3, and 4 were observed in 16 (6.4%), 41 (16.4%), 189 (75.6%), and 4 (1.6%) patients, respectively. With a median follow-up of 72.5 months, the 5- and 8-year overall survival rates were 87.5% and 84.2%, respectively; the 5- and 8-year local control rates were 94.4% and 92.9%, respectively. At the last follow-up, 19 of 250 patients (7.6%) underwent enucleation, 15 due to local recurrence and 4 due to AEs. Secondary glaucoma grades 1, 2, and 3-4 were observed in 22 (8.8%), 49 (19.6%), and 5 patients (2.0%), respectively. At the last follow-up, ≥ EV, ≥ CF, and ≥ LP were maintained in 80 (33%), 120 (49%), and 154 (63%) patients, respectively. Preservation rate of ≥LP vision at 5 and 8 years after CIRT was 65.7% and 55.3%, respectively. CIRT for CMM is a promising treatment for both tumor control and preservation of the eye and VA.

Early postoperative silicone oil migration causing wound gape with secondary glaucoma and reversal with prone positioning

Early postoperative silicone oil migration causing wound gape with secondary glaucoma and reversal with prone positioning

Ciliary body myxoid epithelioid sarcoma in a cat: a case report

BackgroundThe majority of primary, intraocular tumors in cats originate from the uvea and include feline diffuse iris melanoma, lymphoma, and iridociliary epithelial adenoma or adenocarcinoma. In this case report, we describe for the first time the clinical, histological, and immunohistochemical findings of a rare myxoid intraocular neoplasm arising from the ciliary body in a cat.Case presentationA 14-year-old, female, spayed domestic shorthaired cat was presented for evaluation of discolouration of the right eye. Upon examination, a clear to light whitish-tan, bubble-shaped intraocular mass adherent to the inferior ciliary body and extending into the anterior chamber was noted. Within five weeks, the tumor was significantly larger and the eye had developed secondary glaucoma so was enucleated. Light microscopic examination of the globe revealed a multinodular, hypocellular neoplasm arising from the ciliary body composed of interwoven spindle cells embedded in abundant amounts of a lightly basophilic myxoid matrix. Neoplastic cells exhibited strong immunoreactivity for cytokeratin while also showing moderate to strong immunoreactivity to vimentin. A diagnosis was therefore made of an unusual intraocular myxoid epithelioid sarcoma arising from the ciliary body.ConclusionsAlthough apparently exceedingly rare, epithelioid myxosarcoma should be included as a differential diagnosis for intraocular tumors in cats and they represent a clinical, histologic, and immunohistochemical diagnostic challenge. Early surgical intervention should be considered to prevent local invasion and ascension to the brain.

A case of masquerade syndrome caused by metastatic iris tumor diagnosed by a high CEA level in the aqueous humor and iris biopsy

BackgroundWith the advent of targeted therapies, the survival prognosis for metastatic tumors has extended, and it has become necessary to diagnose and consider treatment that takes into account Quality of Life for metastatic tumors of the eye. The reports of checking tumor marker in the aqueous humor for diagnosis of metastatic intraocular tumors are few. Here, we report a case of masquerade syndrome with secondary glaucoma in which a high carcinoembryonic antigen (CEA) level in the aqueous humor could assist diagnosis, and continuing targeted therapy and trabeculectomy were effective.Case presentationA 73-year-old man was referred to us for iritis and high intraocular pressure (IOP) with severe eye pain in the left eye. He had Stage IVB lung adenocarcinoma treated with a molecularly targeted drug, Osimertinib. His best corrected visual acuity was 0.15, and IOP was 52 mmHg in the left eye. Anterior chamber cells (+), numerous small nodules in the iris, and small masses in the inferior angle were observed. In the aqueous humor, the CEA level was higher than in the blood. Napsin A and Thyroid Transcription Factor-1 (TTF-1) positive cells showed in the resected tissue at iridectomy performed during trabeculectomy. The pathological diagnosis of metastatic iris tumor of the lung adenocarcinoma was made, and we injected bevacizumab intravitreally once and continued Osimertinib. His IOP lowered to 8–10 mmHg, and the iris masses disappeared. He lost vision by metastasis to the left optic nerve after termination of Osimertinib one and a half years later. The metastasis shrank after restarting the drug. He passed away from an exacerbation of his primary lung cancer two years and nine months after the first visit. Although he lost vision in his left eye, the metastatic tumor in his left eye and optic nerve had disappeared, and his quality of life was maintained without any pain in his eye.ConclusionsChecking tumor markers in the aqueous humor can aid in diagnosis, and aggressive treatment of metastatic iris tumors must help maintain patients’ Quality of Life.