BACKGROUND: Goniodysgenesis is an inherited maldevelopment of the iridocorneal angle that can ultimately lead to glaucoma. The development of the angle consists of two aspects that often occur concurrently. One process is a shifting of the angle recess of the iridocorneal angle peripherally and posteriorly and the other is a differentiation of the trabecular meshwork. Disruption of either process results in goniodysgenesis. With careful slit-lamp and gonioscopic examination, many different types of goniodysgeneses can be characterized.
CASE REPORT(S). A 24-year-old Hispanic male with a past medical history of untreated glaucoma for ten years presented with a chief complaint of a two-year history of nocturnal eye pain. Best corrected visual acuities were 20/20 OD and OS with a moderate myopic refractive error. Slit-lamp exam revealed normal-sized cornea and uveal adhesions that extended from the iris frill to the lens. Gonioscopy showed open but poorly developed angle structures with elongated and anteriorly placed processes adhering the iris to the cornea. The presumed trabecular meshwork was covered by a golden brown layer of pigment. Dilated exam revealed posterior synechiae attaching the iris to the lens. The intraocular pressures were 36 mmHg OD and 30 mmHg OS. Cup-to-disc ratios and visual fields were all normal. After two weeks of using Timoptic 0.5% BID OD, the patient's intraocular pressure decreased to 24 mmHg OD and 23 mmHg OS. He is currently being evaluated for further intraocular pressure reduction on another glaucoma medication.
CONCLUSIONS. Goniodysgenesis with and without glaucoma may go undiagnosed without proper evaluation. This case represents one type of goniodysgenesis with an arrest in iridocorneal angle development evident by the ocular characteristics similar to those seen during early weeks of normal gestation. The poster will detail the above case and discuss the differentiation, progression and prognosis of this rare clinical presentation.