A CASE OF SPONTANEOUS SUPRACHOROIDAL HEMORRHAGE WITH SECONDARY ANGLE-CLOSURE GLAUCOMA IN A PATIENT WITH ARMD

Title A CASE OF SPONTANEOUS SUPRACHOROIDAL HEMORRHAGE WITH SECONDARY ANGLE-CLOSURE GLAUCOMA IN A PATIENT WITH ARMD
Author, Co-Author Nathan Rock
Topic
Year
2013
Day
Program Number
R02013144
Room
Room 6C
Affiliation
Abstract BACKGROUND:
A patient is triaged for urgent evaluation due to abnormal anterior segment teleretinal imaging and is found to have a massive suprachoroidal hemorrhage with secondary angle-closure glaucoma related to neovascular macular degeneration and anti-coagulant therapy.

CASE REPORT(S):
I
Demographics
72 YO WM
CC:
Red eye OD for 2 weeks, pain and vision loss for 5 days referred due to abnormal teleretinal imaging.
PMH
Type 2 DM
HTN
CHF, h/o MI
Asthma, COPD
PTSD, Depr
POH
(-) Trauma, Surgery
No h/o diabetic retinopathy
Non-exudative ARMD OU
Meds
Albuterol
Fluoxetine
Furosemide
Gemfibrozil
Glipizide
Losartan
Metoprolol
Tiotropium
ASA 325
Januvia
Coumadin

II
Clinical
Dist VA cc:
OD: NLP
OS: 20/60 PH=NI
Pupils:
OD: 5mm, fixed, 4+ APD OD
OS: 5/3 mm, 1+ reactive
VF: OD: NLP OS: sup-nas restr
Physical
K: OD: diffuse microcystic edema, 1+ endo blood staining OS: cl
Conj: OD: 2+ hyperemia OS: W&Q
AC: OD: marked shallowing with temporal irido-corneal touch, 2+ diffuse hyphema OS: normal
Iris: (-)NVI OU, OD details obscured
Tonometry: OD: 52 OS: 13
DFE OS only (no view OD)
Lens: 2+NS/CS
Vitr: cl
Disc: 0.3R, normal
PP/periph: Massive subretinal/sub-RPE heme extending temp to equator sparing fovea; 2+ arteriolar attenuation
BP: 147/84
B-scan OD: Appositional choroidal detachment, hemorrhagic
IVFA OS: hemorrhagic disciform lesion with occult leakage
Labs
CBC, PT/INR, PTT, LFT's, CHEM-7

III
Primary
Spontaneous suprachoroidal hemorrhage with secondary angle-closure glaucoma OD, neovascular ARMD OS
Others
Choroidal melanoma
PDR
Trauma

CONCLUSIONS:
IV
Rare form of choroidal hemorrhage with secondary angle closure glaucoma related to neovascular ARMD and anti-coagulant use triaged from abnormal teleretinal imaging results.
V
Lowered OD IOP in office. Rxed Atropine, Iopidine, Dorzolamide BID OD which improved comfort. Avastin injection OS. Follow-up pending. Low vision referral.
Bibliography
11 ref on file
VI
With neovascular ARMD and anti-coagulant use, maintain low INR and monitor frequently.
Teleretinal imaging increases adherence to eye exams and can detect other pathology.
Affiliation of Co-Authors
Outline