MANAGEMENT OF JUVENILE OPEN ANGLE GLAUCOMA

WITH CONCOMITANT ANTERIOR UVEITIS

Raden Irwanto Adinugroho, M. Ma’sum Effendi, Lely Retno Wulandari, Aulia Abdul Hamid
Department of Ophthalmology, Faculty of Medicine, Universitas Brawijaya,
Saiful Anwar General Hospital Malang, Indonesia

PURPOSE

To report a rare case and management of Juvenile Open Angle Glaucoma (JOAG) with concomitant anterior uveitis

SETTING

Pediatric and strabismus outpatient clinic, glaucoma outpatient clinic at Dr. Saiful Anwar General Hospital Malang, October 2020

METHODS

A case report of boy, 9 years old from ophthalmology department Dr. Saiful Anwar General Hospital with Juvenile Open
Angle Glaucoma with concomitant anterior uveitis who was hospitalized and underwent complete ocular examination
including visual acuity (VA), anterior and posterior segment, intraocular pressure (IOP), visual field (VF) examination, optic
nerve optical coherence tomography (OCT), trabeculectomy and steroid coverage before and after surgery

The authors of this case report have no financial disclosure

 Name: RAIHAN R, MUHAMMAD OD OS

RESULT
ID: 11487735 Exam Date: 7/10/2020 7/10/2020 CZMI
DOB: 6/13/2001 Exam Time: 10:55 AM 10:56 AM
Gender: Male Serial Number: 5000-8186 5000-8186

History Taking
Technician: Operator, Cirrus Signal Strength: 6/10 6/10

ONH and RNFL OU Analysis:Optic Disc Cube 200x200 OD OS

• Blurred vision on both eyes since 1 RNFL Thickness Map RNFL Thickness Map

week prior to hospital visit

• Left eye more blurred than right eye
• Pain (-), narrowing of visual field (-),
seeing halo (-),Nausea and vomiting (-),
Figure 1. Anterior segment of RE :
mid-dilatation pupil (yellow arrow) RNFL Deviation Map
Neuro-retinal Rim Thickness
RNFL Deviation Map

diplopia(-),redness(-), tearing (-), deep anterior chamber (blue arrow)

discharge (-) photophobia (-)
Disc Center(0.35,-0.22)mm Disc Center(0.48,-0.51)mm
RNFL Thickness
Extracted Horizontal Tomogram Extracted Horizontal Tomogram

Clinical Presentation
• Visual Acuity : RE Best corrected were Figure 2. Anterior segment of LE : Extracted Vertical Tomogram Extracted Vertical Tomogram

6/6, LE 1/300 mid-dilatation pupil and Posterior

• Iris neovascularization on both eyes subcapsular cataract (yellow arrow) RNFL

• No keratic precipitate (KPs), 1+ flare, deep anterior chamber (blue arrow) RNFL Circular Tomogram
Quadrants
RNFL Circular Tomogram

1+ cells on RE and no KPs, 1+ flare, 3+ RNFL

Clock

cells on LE. Deep anterior chamber Hours

with open angle on gonioscopy Comments Doctor's Signature

SW Ver: 11.0.0.29946
Copyright 2018

• Intraocular pressure (IOP) was 30,4

Carl Zeiss Meditec, Inc

Figure 5. Optic nerve OCT: thinning of

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Analysis Edited: 7/10/2020 11:02 AM Page 1 of 1

mmHg in RE and 22,9 mmHg in LE retinal nerve fiber layer at superior and
• Posterior subcapsular cataract on LE Figure 3. RE Figure 4. LE
inferior quadrant of both eyes. Vertical
• C/D ratio was 0.8 in both eyes Funduscopy Funduscopy
C/D ratio was 0.8 in both eyes
 Diagnosis
Juvenile Open Angle Glaucoma with Concomitant
Anterior Uveitis

Management Figure 6. Iris coloboma Figure 7. elevated Figure 8. Deep

• RE trabeculectomy and subconjungtival post trabeculectomy and non fibrotic anterior chamber
injection of 5-fluorouracil intraoperatively on right eye (blue bleb on right eye on right eye
• Oral methylprednisolone 4mg tid and arrow) (black arrow) (yellow arrow)
fluorometholone eye drop 6 times daily
on both eyes since 1 week preoperatively IOP of RE was successfully
and gradually tappered maintained around 8 mmHg Video 1. Video
and no inflamation flare-up during surgery
CONCLUSION for 2 months

• JOAG is a kind of primary open angle glaucoma which increased intraocular pressure and occurs in adolescene or
young adult
• Trabeculectomy was effective to maintain a normal IOP in juvenile open angle glaucoma case with bad compliance and
last eye
• No postoperative inflamation flare-up was noted, due to steroid coverage before and after surgery
Contact : Raden Irwanto Adinugroho
Irwan.201291@gmail.com +6281294640871
Department of Ophthalmology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
Permission has been obtained for all photos and video