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SIMULTANEOUS BILATERAL ACUTE ANGLE-CLOSURE GLAUCOMA IN MILLER FISHER SYNDROME
Summary
This case report details a rare instance of Miller Fisher syndrome (MFS) complicated by acute angle-closure glaucoma. Prompt treatment led to significant visual recovery and normalized intraocular pressure.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barré syndrome, characterized by ophthalmoplegia, ataxia, and areflexia.
- Acute angle-closure glaucoma (AACG) is an ophthalmic emergency caused by a sudden blockage of aqueous humor outflow.
Observation:
- A 71-year-old female with MFS presented with total ophthalmoplegia, ataxia, areflexia, and simultaneous bilateral AACG.
- Initial presentation included severely elevated intraocular pressure (IOP) and corneal edema, with hand motion visual acuity in both eyes.
Findings:
- Intravenous mannitol and topical glaucoma medications rapidly reduced IOP to normal levels.
- Peripheral Nd:YAG laser iridotomy was performed prophylactically.
- Subsequent cataract surgery with posterior chamber lens implantation significantly improved visual acuity to 1.0 OD and 0.8 OS.
- The patient maintained normal IOP without glaucoma medication at a 3-year follow-up.
Implications:
- This is the second reported case of MFS with simultaneous bilateral AACG, highlighting a rare but serious ocular complication.
- Effective management involving medical, laser, and surgical interventions can lead to excellent visual outcomes in such complex cases.
- Early recognition and prompt treatment are crucial for preserving vision in patients with MFS and concurrent glaucoma.
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