Fall 2017 Newsletter

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Fall 2017 Newsletter
7th Residency Announcement

Exciting Residency Announcement!

ACGME approves seventh resident complement; first increase in over 30 years!

Grand Rounds

Grand Rounds and Case Studies

Check out our weekly presentations

OTEP

OTEP

Ophthalmic Technician Education Program

LARGEST STUDY ON CHINESE AMERICANS PUBLISHED

LARGEST STUDY ON CHINESE
AMERICANS PUBLISHED

USC Ophthalmology Researchers Find More
Effective Treatments For Blinding Eye Diseases

EDUCATION

Case Study: May the Schwartz Be With You

Lee Reznik
Presenter: On-Tat Lee, MD Discussant: Alena Reznik, MD
 

History

  • 55-year-old male presents with progressive peripheral vision loss in his left eye occurring over several years
  • Associated with persistent floaters and photopsia
  • History of distant ocular trauma. Patient was a high-school football player and sustained several concussions and was also punched in the eye as a teenager.

Exam Findings

  • VA: 20/15 // CF @ 4ft ph 20/300
  • RAPD OS
  • IOP 15, 42
  • SLE: Unremarkable OU except lightly pigmented debris in anterior chamber OS
  • Gonioscopy – OD: open to CB 360; OS: open to CB 360 without evidence of angle recession, peripheral anterior synechiae, NVA or increased pigmentation
Figure 1
Figure 1: Dilated fundoscopy reveals a healthy appearing right optic nerve with pink and sharp margins and a 0.3 cup-to-disc ratio. There is no saucerization, notching or other changes noted within the right optic nerve. However, the left optic nerve exhibits deep cupping with a 0.9 cup-to-disc ratio and mild peripapillary atrophy.

 

Differential Diagnosis

  • Schwartz-Matsuo syndrome
  • Angle recession glaucoma with traumatic retinal detachment
  • Pseudoexfoliation glaucoma
  • Pigmentary glaucoma
  • Posner-Schlossman syndrome (glaucomatocyclitic crisis)
  • Uveitic glaucoma

Additional Investigations

Figure 2
Figure 2: Subtle, shallow superior retinal detachment from 10 to 12 o’clock extending to the optic nerve. May have resulted from a small atrophic hole (subclinical) with extension of subretinal fluid to posterior pole.
Figure 2
Figure 3: B-scan showing high reflective, low mobile membrane with optic nerve insertion in superonasal quadrant (from 7 to 2 o’clock), low lying, consistent with retinal detachment.

 

Diagnosis

  • Schwartz-Matsuo syndrome

Pathophysiology

  • Rhegmatogenous retinal detachment (RRD) is frequently associated with reduced IOP thought to be from a decrease in aqueous production or an increase in aqueous outflow. In long-standing RRDs, photoreceptor outer segments may be released in sufficient quantities to obstruct aqueous outflow at the trabecular meshwork causing elevation of IOP. Retina reattachment surgery can normalize the high IOP.

Treatment

  • Treatment goals should focus on repair of the retinal detachment and expeditious IOP control

Prognosis and Future Directions

  • After successful retinal detachment repair, the anterior chamber cellular debris often disappears and IOP tends to normalize
  • Visual potential often depends on early diagnosis and treatment. Glaucoma may be so prominent that the underlying treatable cause of retinal detachment may be overlooked.

References

  • Schwartz A. Chronic open-angle glaucoma secondary to rhegmatogenous retinal detachment. Am J Ophthalmol. 1973;75:205-211.
  • Davidorf FH. Retinal pigment epithelial glaucoma. Ophthalmol Dig. 1976;38:11-16.
  • Matsuo T. Photoreceptor outer segments in aqueous humor: key to understanding a new syndrome. Surv Ophthalmol. 1994;39:211-233.
  • Kooner KS, Zimmerman TJ. Differential diagnosis of unilateral glaucoma: Part I: Definition and classification. Ann Ophthalmol. 1983 Aug;15(8):695-7.
  • Chen X, Richter GM, Caprioli J, McCannel TA. Macular Microcysts in Schwartz-Matsuo Syndrome. Retin Cases Brief Rep. 2016 Dec 20.
  • Matsuo T, et al. Schwartz-Matsuo Syndrome in Retinal Detachment with Tears of the Nonpigmented Epithelium of the Ciliary Body. Acta Ophthalmol Scand. 1998:76(4);481-485.
  • Netland PA. Elevated intraocular pressure secondary to Rhegmatogenous Retinal Detachment. Surv Ophthalmol. 39:234-240.
  • Phelps CD, Burton TC. Glaucoma and retinal detachment. Arch Ophthalmol. 1977 Mar;95(3):418-422.

Contact

Section Editors

 

Produced by: Monica Chavez, John Daniel, Joseph Yim and Dr. Vivek Patel
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