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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 54

Wet age-related macular degeneration and choroidal effusion as a cause of angle closure


Department of Ophthalmology, Northampton General Hospital, Cliftonville, Northampton, UK

Date of Submission23-Jan-2020
Date of Acceptance12-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Christina Saekyung Lim
Ophthalmology Department, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW
UK
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_151_20

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  Abstract 


Keywords: Age-related macular degeneration, angle-closure, choroidal effusion, glaucoma


How to cite this article:
Lim CS, Tonne P, Mukherji S. Wet age-related macular degeneration and choroidal effusion as a cause of angle closure. Indian J Ophthalmol Case Rep 2021;1:54

How to cite this URL:
Lim CS, Tonne P, Mukherji S. Wet age-related macular degeneration and choroidal effusion as a cause of angle closure. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 27];1:54. Available from: https://www.ijoreports.in/text.asp?2021/1/1/54/305487



A 74-year-old female presented to eye casualty with pain in the left eye (LE). She was known to have wet age-related macular degeneration (ARMD) in both eyes. LE was previously treated but it was stopped due to poor vision. She was still phakic in the LE.

The visual acuity was counting fingers in LE. Following examination, a diagnosis of acute angle-closure was made with intraocular pressure (IOP) of 66 mmHg. The patient was treated by topical IOP-lowering treatment, intravenous acetazolamide, and bilateral peripheral iridotomies. Due to the hazy view, B-scan ultrasonography was performed which showed raised macula [Figure 1]a. Macula optical coherence tomography (OCT) of the LE taken 5 months before the presentation showed the central macular thickness of 999 μ [Figure 1]b. She presented again to the eye casualty 4 days later with recurrent angle closure and the IOP of 40 mmHg. Following IOP control, she was treated by phacoemulsification and intraocular lens insertion 1 month later. There has been no recurrence to the present.
Figure 1: (a) B-scan image of the LE (b) Macula OCT of LE

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  Discussion Top


Massive retinal hemorrhages in wet ARMD is a recognized cause of secondary acute angle closure (AAC).[1] It is suggested that the physical pressure of pushing the lens forward causes the angle closure.[2] Macular hemorrhages can also cause AAC in patients with preexisting shallow angles.[2] Similarly, AAC has also been observed in Coat's disease as its first presentation associated with macular exudation.[3] Herein, we describe a case of AAC caused by untreated wet ARMD and choroidal effusion without the presence of hemorrhage, and to our knowledge, this has not been previously described. It would be standard practice to treat wet ARMD in a seeing eye, however, the treatment stops when the eye loses the vision potential. It may be important to consider AAC as a possible consequence of wet ARMD in a blind eye.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Liu YC, Lau LI, Lee FL, Ko YC, Hsu WM. Recurrent acute angle-closure attacks in age-related macular degeneration-associated massive posterior segment hemorrhage. Jpn J Ophthalmol 2009;53:190-1.  Back to cited text no. 1
    
2.
Williams GS, Anderson L, Eddyshaw D. Macular hemorrhage as a cause of acute angle closure. Indian J Ophthalmol 2013;61:683-4.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Amro M, Haydar AA, El-Khoury S, Tomey KF, Cherfan G, Khoueir Z. Acute angle-closure glaucoma as a first presentation of coats' disease: A case report. J Glaucoma 2018;27:e33-6.  Back to cited text no. 3
    


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