A CASE OF NORMAL TENSION GLAUCOMA COEXISTENCE OF PITUITARY MACROADENOMA

Title A CASE OF NORMAL TENSION GLAUCOMA COEXISTENCE OF PITUITARY MACROADENOMA
Author, Co-Author Yi Pang, Richard parrish II, John McSoley
Topic
Year
2005
Day
Program Number
055253
Room
Affiliation
Illinois College of Optometry
Abstract BACKGROUND: There are more difficulties of diagnosing and treating normal tension glaucoma (NTG) compared to other types. At the meantime, clinician may be challenged by more than one problem in patient care. We report a NTG patient coexistence of a pituitary macroadenoma.

CASE REPORT(S): A 66-year-old female presented for second opinion about NTG at the Bascom Palmer Eye Institute with compliant of vision decline for 6 months and worse in past 2 months. Patient was under the treatment of NTG for 4 years.

The best corrected visual acuity was 20/80 OD and 20/60 OS. Intraocular pressure was 22 OD, 18 OS. Suspicious cupping, peripapillary atrophy and moderate optic nerve pallor were detected in both eyes. Inferior nasal depressions that extended in an inferior arcuate fashion were detected OU with Humphrey visual field testing. Of particular note were temporal depressions that respected the vertical midline in both eyes. Magnetic resonance imaging (MRI) was ordered and revealed a large sella and suprasellar mass, with characteristics suggesting a pituitary macroadenoma.

The pituitary tumor was removed. Bi-temporal visual field defect improved dramatically and optic nerve pallor changed from moderate to mild 6 month post-surgery. The best corrected visual acuity was 20/30 in each eye and intraocular pressure was 14 OD and 12 OS. Optic nerve photographs, visual field plots, and MRI of pre- and post-surgery will be presented.
CONCLUSIONS: This case alerts clinicians the potential for the existence or development of more than one problem in patient care. Our patient had a diagnosis of NTG with characteristic optic nerve features and visual field abnormalities. An additional diagnosis was supported by additional and subsequent clinical findings; however, there is chance to misdiagnosis if the decreased visual acuity and optic nerve pallor did not catch the clinician’s attention and visual field was not ordered. In our case, accurate evaluation and successful surgery secured visual function recovery and a dramatic improvement of visual field.
Affiliation of Co-Authors Bascom Palmer Eye Institute, Bascom Palmer Eye Institute
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