case_images: PMC11793078_01
case_images: Anterior segment of the RE during initial presentation, showing generalized corneal edema (due to high IOP) with brown pigment on the inferior cornea and anterior lens capsule.. RE, right eye; IOP, intraocular pressure
case_images: cureus-0017-00000076946-i01.jpg
case_images: PMC11793078_01_cureus-0017-00000076946-i01.jpg
case_images: FIG1
case_images: RE AC (Figure 1 and Figure 2) revealed conjunctival injection, hazy cornea with AC cells of 1+, brown pigment over the inferior cornea, and anterior lens capsule. RE cup-disc ratio (CDR) was 0.3 with no evidence of posterior uveitis.
case_images: Slit-lamp image showing inferior KPs, indicative of endothelial involvement commonly seen in CMV AU.. CMV, cytomegalovirus; AU, anterior uveitis; KPs, keratic precipitates
case_images: cureus-0017-00000076946-i02.jpg
case_images: PMC11793078_01_cureus-0017-00000076946-i02.jpg
case_images: FIG2
case_images: RE AC (Figure 1 and Figure 2) revealed conjunctival injection, hazy cornea with AC cells of 1+, brown pigment over the inferior cornea, and anterior lens capsule. RE cup-disc ratio (CDR) was 0.3 with no evidence of posterior uveitis.
case_images: PMC11793078_02
case_images: Anterior segment of LE showing sectoral iris atrophy at 2 o'clock and 10 o'clock positions (white arrows), suggestive of viral uveitis. Also, note the presence of the XEN implant at the 12 o'clock position (black arrow).. LE, left eye
case_images: cureus-0017-00000076946-i03.jpg
case_images: PMC11793078_02_cureus-0017-00000076946-i03.jpg
case_images: FIG3
case_images: AC examination (Figure 3) showed sectoral iris atrophy, AC cells 1+ with the presence of old KPs on the cornea, and lens nucleosclerosis 2+, with a CDR of 0.6. In view of the high suspicion of viral AU, as evidenced by sectoral iris atrophy, recurrent episodes of AU with high IOP, and the presence of KPs, AC paracentesis was performed. An aqueous sample was sent for HSV1/2, CMV, and VZV RT-PCR, and the result was positive for CMV. A joint decision was made for LE phacoemulsification with IOL and XEN implantation (Figure 3 and Figure 4) in view of moderately elevated IOP.
case_images: Gonioscopy of the LE post-phacoemulsification, IOL implantation, and XEN implantation showing the XEN implant in situ. The XEN implant creates a new drainage pathway for aqueous humor to flow from the AC to the subconjunctival space, thereby reducing IOP.. AC, anterior chamber; LE, left eye; IOP, intraocular pressure; IOL, intraocular lens
case_images: cureus-0017-00000076946-i04.jpg
case_images: PMC11793078_02_cureus-0017-00000076946-i04.jpg
case_images: FIG4
case_images: A joint decision was made for LE phacoemulsification with IOL and XEN implantation (Figure 3 and Figure 4) in view of moderately elevated IOP.
case_images: OCT RNFL before LE phacoemulsification, IOL implantation, and XEN implantation. Note the LE central RNFL thickness of 64 microm with evidence of superior RNFL thinning (highlighted in red).. LE, left eye; IOL, intraocular lens; OCT, optical coherence tomography; RNFL, retina nerve fiber layer
case_images: cureus-0017-00000076946-i05.jpg
case_images: PMC11793078_02_cureus-0017-00000076946-i05.jpg
case_images: FIG5
case_images: He showed no glaucoma progression as evidenced by serial optical coherence tomography (OCT) retina nerve fiber layer (RNFL) and Humphrey visual field (HVF) (Figures 5-8).
case_images: Six-month post-intervention OCT RNFL showing a similar pattern of superior RNFL thinning with central RNFL thickness of 76 (not worsening). The improvement could be the result of cataract extraction improving the signal strength.. OCT, optical coherence tomography; RNFL, retina nerve fiber layer
case_images: cureus-0017-00000076946-i06.jpg
case_images: PMC11793078_02_cureus-0017-00000076946-i06.jpg
case_images: FIG6
case_images: He showed no glaucoma progression as evidenced by serial optical coherence tomography (OCT) retina nerve fiber layer (RNFL) and Humphrey visual field (HVF) (Figures 5-8).
case_images: Pre-intervention HVF showing inferior arcuate scotoma (in pattern deviation) correlating well with superior RNFL thinning from OCT (Figure 5). Also, note the VFI of 83%.. VFI, visual field index; HVF, Humphrey visual field; OCT, optical coherence tomography
case_images: cureus-0017-00000076946-i07.jpg
case_images: PMC11793078_02_cureus-0017-00000076946-i07.jpg
case_images: FIG7
case_images: He showed no glaucoma progression as evidenced by serial optical coherence tomography (OCT) retina nerve fiber layer (RNFL) and Humphrey visual field (HVF) (Figures 5-8).
case_images: Six-month post-intervention HVF showing inferior arcuate scotoma (similar visual field defect). The slight improvement of VFI to 90% could be due to cataract extraction.. VFI, visual field index; HVF, Humphrey visual field
case_images: cureus-0017-00000076946-i08.jpg
case_images: PMC11793078_02_cureus-0017-00000076946-i08.jpg
case_images: FIG8
case_images: He showed no glaucoma progression as evidenced by serial optical coherence tomography (OCT) retina nerve fiber layer (RNFL) and Humphrey visual field (HVF) (Figures 5-8).
case_images: PMC11793078_03
case_images: Anterior segment of LE post-trabeculectomy + mitomycin C showing superotemporal bleb.. LE, left eye
case_images: cureus-0017-00000076946-i09.jpg
case_images: PMC11793078_03_cureus-0017-00000076946-i09.jpg
case_images: FIG9
case_images: LE trabeculectomy with mitomycin C 0.03% was performed (Figure 9 and Figure 10).
case_images: A closer view of the LE superotemporal quadrant showing a functional bleb extending from 11 o'clock to 2 o'clock.. LE, left eye
case_images: cureus-0017-00000076946-i10.jpg
case_images: PMC11793078_03_cureus-0017-00000076946-i10.jpg
case_images: FIG10
case_images: LE trabeculectomy with mitomycin C 0.03% was performed (Figure 9 and Figure 10).
case_images: Pre-trabeculectomy OCT RNFL showing LE CDR of 0.7 with central RNFL thickness of 65. There was associated superior and inferior RNFL thinning (highlighted in red).. OCT, optical coherence tomography; RNFL, retina nerve fiber layer; LE, left eye; CDR, cup-disc ratio
case_images: cureus-0017-00000076946-i11.jpg
case_images: PMC11793078_03_cureus-0017-00000076946-i11.jpg
case_images: FIG11
case_images: There was no evidence of progression of glaucoma after trabeculectomy (Figures 11-13).
case_images: Five-month post-trabeculectomy OCT RNFL showing a similar pattern of superior and inferior RNFL thinning with central RNFL thickness of 64.. OCT, optical coherence tomography; RNFL, retina nerve fiber layer
case_images: cureus-0017-00000076946-i12.jpg
case_images: PMC11793078_03_cureus-0017-00000076946-i12.jpg
case_images: FIG12
case_images: There was no evidence of progression of glaucoma after trabeculectomy (Figures 11-13).
case_images: OCT RNFL two years eight months post-trabeculectomy showing lack of glaucoma progression despite bleb failure. OCT shows a central RNFL thickness of 60 with similar superior and inferior thinning.. OCT, optical coherence tomography; RNFL, retina nerve fiber layer
case_images: cureus-0017-00000076946-i13.jpg
case_images: PMC11793078_03_cureus-0017-00000076946-i13.jpg
case_images: FIG13
case_images: There was no evidence of progression of glaucoma after trabeculectomy (Figures 11-13).
case_images: PMC11793078_04
case_images: LE HVF dated 2018 from the primary treating hospital showing moderate glaucomatous changes of inferior arcuate scotoma with VFI of 94%. Despite this, the patient refused to be referred for surgical intervention.. LE, left eye; HVF, Humphrey visual field; VFI, visual field index
case_images: cureus-0017-00000076946-i14.jpg
case_images: PMC11793078_04_cureus-0017-00000076946-i14.jpg
case_images: FIG14
case_images: HVF (Figure 14). However, he refused.
case_images: LE HVF five years later after recurrent episodes of AU with high IOP. Note the worsening of VFI to 60% with double arcuate scotoma in pattern deviation.. LE, left eye; HVF, Humphrey visual field; VFI, visual field index; IOP, intraocular pressure; AU, anterior uveitis
case_images: cureus-0017-00000076946-i15.jpg
case_images: PMC11793078_04_cureus-0017-00000076946-i15.jpg
case_images: FIG15
case_images: HVF and OCT RNFL of the LE showed advanced glaucomatous changes (Figure 15 and Figure 16).