**4. Main points in diagnosis and treatment of complications of PSS**

Other kinds of glaucoma which PSS concurred with or lead to were introduced before. PSS can also concur with or cause iris heterochromia, ischemic optic neuropathy, complicated cataract and other diseases, such as retinal detachment. Main points in diagnosis and treatment of these complications were briefly introduced as follows:

#### **4.1. PSS combined with iris heterochromia**

#### **Typical cases**

1) The patients came to our hospital because his left eye suffered from intermittent recurrent pain and blurred vision for more than one year. Intraday examinations showed: best corrected visual acuity is 1.0/ 0.6(R/L), IOP: 16.7/ 13.7(R/L) mmHg, FFA in both eyes are normal, optic cup in his left eye is expand. He was suspected of glaucoma. Intermittent recurrent pain and blurred vision kept to attack his left eye for more than half a year after then. These attacks usually ceased a few days late, with or without the help of 0.5% timolol eye drop and other drugs. During this period, the highest IOP record of his left eye was 35mmHg with a normal record of his right eye. The patient returned to our hospital one year later after stopping use of any drugs for two weeks. Ophthalmologic examination at this time showed: visual acuity 1.2 both eyes, IOP 17/15(R/L)mmHg, a lot of small lipid-like KP in the inferior of the left cornea, "rain dozen sand -like" appearance in the iris of his left eye, C/D rate 0.6/0.7(R/L),CCT 553/ 560(R/L). Results of his visual field and OCT showed in Figure below. UBM showed wideangle in the both eyes. Fundus fluorescein angiography and contrast sensitivity revealed no special finds. 24 hours IOP measurements(2 weeks after KP disappeared): 13~16/ 12~15(R/L) mmHg. Diagnosis of "PSS complicated with iris heterochromia" for his left eye was confirmed than.He was asked to treat every onset of the disease in time with drugs dropping IOP as well as anti-inflammatory medicine. (Clinical data see Figure 19)

2) She was admitted to our hospital because her right eye suffered from repeated episodes of pain with blurred vision for more than nine years, and her vision decreased 3 months, with a primary diagnosis of "secondary glaucoma" for her right eye. A lot of intermittent recurrent pain and blurred vision had attacked her right eye from nine years ago, 2 or 3 times a year. Each attack lasted about one week, than resolved spontaneously. Three months ago her sense of vision went to recession. She felt that her right eye was attacked again recent days, so she can to our hospital. Ophthalmologic examination in this time showed: visual acuity: 0.15/ 1.0 (R/L), IOP: 43/12(R/L) mmHg, mist edema in her cornea of her right eye with a lot of fat-like

KP, pale and"rain scatting beach-like" appearance in her left iris with a round pupil about 3mm in diameter, her optic disk appeared pale in color with a C/D 0.9, her anterior chamber is not shallow, ultrasound biomicroscopy (UBM) showed a wide angle in both eye. Her left eye showed no KP with a C/D less 0.3. Her systemic examination and routine inspection and examination showed no special finds. Treatment with drugs dropping IOP such as carteolol and brimonidine and even mannitol as well as anti-inflammatory medicine such as loteprednol kept about a week, KP significantly reduced but the intraocular pressure is still high. Operation

**Figure 18.** Typical clinical data of patient (Clinical number: 341555) suffered from left PSS combined with binocular closed-angle glaucoma. The visual fields of right eye(A) and left eye(B) become worse 4 years later(C) and (D), UBM indicate binocular aqueous humour outflow after the 1st trabeculectomy(E) and the OCT results show serious retinal

Clinical Research Progress of Glaucomatocyclitic Crisis

http://dx.doi.org/10.5772/54335

409

nerve fiber layer defect in left eye (F).

in the last 2 years. She was hospitalized once more, and another trabeculectomy was performed on the left eye near the first one, at the end of which the two filtering blebs(an original and a just manufactured ) were merged into one. She was discharged with an IOP of 12mmHg; the

left eye was no longer attacked after this trabeculectomy ,and the IOP kept stable.

**4. Main points in diagnosis and treatment of complications of PSS**

of these complications were briefly introduced as follows:

as anti-inflammatory medicine. (Clinical data see Figure 19)

**4.1. PSS combined with iris heterochromia**

Other kinds of glaucoma which PSS concurred with or lead to were introduced before. PSS can also concur with or cause iris heterochromia, ischemic optic neuropathy, complicated cataract and other diseases, such as retinal detachment. Main points in diagnosis and treatment

1) The patients came to our hospital because his left eye suffered from intermittent recurrent pain and blurred vision for more than one year. Intraday examinations showed: best corrected visual acuity is 1.0/ 0.6(R/L), IOP: 16.7/ 13.7(R/L) mmHg, FFA in both eyes are normal, optic cup in his left eye is expand. He was suspected of glaucoma. Intermittent recurrent pain and blurred vision kept to attack his left eye for more than half a year after then. These attacks usually ceased a few days late, with or without the help of 0.5% timolol eye drop and other drugs. During this period, the highest IOP record of his left eye was 35mmHg with a normal record of his right eye. The patient returned to our hospital one year later after stopping use of any drugs for two weeks. Ophthalmologic examination at this time showed: visual acuity 1.2 both eyes, IOP 17/15(R/L)mmHg, a lot of small lipid-like KP in the inferior of the left cornea, "rain dozen sand -like" appearance in the iris of his left eye, C/D rate 0.6/0.7(R/L),CCT 553/ 560(R/L). Results of his visual field and OCT showed in Figure below. UBM showed wideangle in the both eyes. Fundus fluorescein angiography and contrast sensitivity revealed no special finds. 24 hours IOP measurements(2 weeks after KP disappeared): 13~16/ 12~15(R/L) mmHg. Diagnosis of "PSS complicated with iris heterochromia" for his left eye was confirmed than.He was asked to treat every onset of the disease in time with drugs dropping IOP as well

2) She was admitted to our hospital because her right eye suffered from repeated episodes of pain with blurred vision for more than nine years, and her vision decreased 3 months, with a primary diagnosis of "secondary glaucoma" for her right eye. A lot of intermittent recurrent pain and blurred vision had attacked her right eye from nine years ago, 2 or 3 times a year. Each attack lasted about one week, than resolved spontaneously. Three months ago her sense of vision went to recession. She felt that her right eye was attacked again recent days, so she can to our hospital. Ophthalmologic examination in this time showed: visual acuity: 0.15/ 1.0 (R/L), IOP: 43/12(R/L) mmHg, mist edema in her cornea of her right eye with a lot of fat-like

(Clinical data see Figure 18)

408 Glaucoma - Basic and Clinical Aspects

**Typical cases**

**Figure 18.** Typical clinical data of patient (Clinical number: 341555) suffered from left PSS combined with binocular closed-angle glaucoma. The visual fields of right eye(A) and left eye(B) become worse 4 years later(C) and (D), UBM indicate binocular aqueous humour outflow after the 1st trabeculectomy(E) and the OCT results show serious retinal nerve fiber layer defect in left eye (F).

KP, pale and"rain scatting beach-like" appearance in her left iris with a round pupil about 3mm in diameter, her optic disk appeared pale in color with a C/D 0.9, her anterior chamber is not shallow, ultrasound biomicroscopy (UBM) showed a wide angle in both eye. Her left eye showed no KP with a C/D less 0.3. Her systemic examination and routine inspection and examination showed no special finds. Treatment with drugs dropping IOP such as carteolol and brimonidine and even mannitol as well as anti-inflammatory medicine such as loteprednol kept about a week, KP significantly reduced but the intraocular pressure is still high. Operation

of Ahmed valve implantation was performed on her right eye two weeks larer. She was discharged a week postoperative with an IOP of 9mmHg in the operated eye. Her IOP was controlled well with fewer attacks of PSS and a stable visual field in the recent 3 years after the

Clinical Research Progress of Glaucomatocyclitic Crisis

http://dx.doi.org/10.5772/54335

411

4 cases of PSS complicated with iris heterochromia were reported [40]. They were 2 males and 2 females aged 35 to 45 years. In addition to typical PSS performance, the iris showed "rain scatting sand-like"appearance in all of the 4 patients. All of them are monocular repeatedly attacked at the same eye. Each attack kept 3 to 7 days with a significantly increased IOP up to 30.00 ~ 60.00mnHg and a few of fat-like KP, than relieve itself or extinct with the help of medication. Intraocular pressure (including 24 hours intraocular pressure) in intermittent period appeared normal after discontinuation of all medication with a typical crossed-over

**2.** Key-points in the differential diagnosis between PSS complicated with iris heterochro‐

The two diseases are different clinically in the following five aspects: the attacked eye and sex of patients, manifestation of intraocular pressure, character of KP, appearance of the Lens and

Most of PSS cases were monocular affected, a few of cases was binocularly attacked but alternately between left and right eye, extremely rare cases was both eye attacked simultane‐ ously. Male patient is more than female in PSS. FH is generally believed that no gender

The IOP in patients of PSS with iris heterochromatic appeared as an intermittent and abruptly rising when the attack comes with the appearance of typical KP in pure PSS patients. IOP elevation in patients of PSS with iris heterochromatic usually lasted 3 ~ 10days, and then turned to subside spontaneously with the disappearance of the KP after this period, it is also sensitive to drugs dropping IOP and anti- inflammatory medicine. On the contrary, IOP of patient with FH appeared normal in the initial stage for a long time, after that,elevated in part of the cases gradually; however, once the intraocular pressure elevated, it often appeared persistently higher, although there maybe some fluctuations. The elevated IOP and KP in patient with FH had no characteristic of intermittent, were difficult to be controlled and poorly responded to

IOP in patients with PSS complicated with iris heterochromatic kept the characteristic of crossed-over, that is, the IOP of the attacked eye was higher than that of contra lateral eye during the episode but lower(3 ~ 5mmHg) than the other eye between attacks. IOP in patients with Fuchs syndrome had no such characteristic, once elevated; it is always higher if untreated.

**1.** Clinical performance of PSS complicated with iris heterochromia

matic and FHI (Fuchs heterochromic iridocyclitis).

differences, more than 90% of the cases was monocularly effected.

Glaucomatous damage of optic nerve and visual field.

**The attacked eye and sex of patients**

**Manifestation of intraocular pressure**

corticosteroids therapy.

operation. (Clinical data see Figure 20)

**Discussion**

phenomenon.

**Figure 19.** Typical clinical data of patient (ID: 11041302) with diagnosis of left PSS combined with iris heterochromia. Visual field of left eye show nasal defect(A), binocular OCT results indicate ocular cups expand(B)and (C)obvious reti‐ nal nerve fiber layer defect(C).

of Ahmed valve implantation was performed on her right eye two weeks larer. She was discharged a week postoperative with an IOP of 9mmHg in the operated eye. Her IOP was controlled well with fewer attacks of PSS and a stable visual field in the recent 3 years after the operation. (Clinical data see Figure 20)

#### **Discussion**

**1.** Clinical performance of PSS complicated with iris heterochromia

4 cases of PSS complicated with iris heterochromia were reported [40]. They were 2 males and 2 females aged 35 to 45 years. In addition to typical PSS performance, the iris showed "rain scatting sand-like"appearance in all of the 4 patients. All of them are monocular repeatedly attacked at the same eye. Each attack kept 3 to 7 days with a significantly increased IOP up to 30.00 ~ 60.00mnHg and a few of fat-like KP, than relieve itself or extinct with the help of medication. Intraocular pressure (including 24 hours intraocular pressure) in intermittent period appeared normal after discontinuation of all medication with a typical crossed-over phenomenon.

**2.** Key-points in the differential diagnosis between PSS complicated with iris heterochro‐ matic and FHI (Fuchs heterochromic iridocyclitis).

The two diseases are different clinically in the following five aspects: the attacked eye and sex of patients, manifestation of intraocular pressure, character of KP, appearance of the Lens and Glaucomatous damage of optic nerve and visual field.

#### **The attacked eye and sex of patients**

Most of PSS cases were monocular affected, a few of cases was binocularly attacked but alternately between left and right eye, extremely rare cases was both eye attacked simultane‐ ously. Male patient is more than female in PSS. FH is generally believed that no gender differences, more than 90% of the cases was monocularly effected.

#### **Manifestation of intraocular pressure**

**Figure 19.** Typical clinical data of patient (ID: 11041302) with diagnosis of left PSS combined with iris heterochromia. Visual field of left eye show nasal defect(A), binocular OCT results indicate ocular cups expand(B)and (C)obvious reti‐

nal nerve fiber layer defect(C).

410 Glaucoma - Basic and Clinical Aspects

The IOP in patients of PSS with iris heterochromatic appeared as an intermittent and abruptly rising when the attack comes with the appearance of typical KP in pure PSS patients. IOP elevation in patients of PSS with iris heterochromatic usually lasted 3 ~ 10days, and then turned to subside spontaneously with the disappearance of the KP after this period, it is also sensitive to drugs dropping IOP and anti- inflammatory medicine. On the contrary, IOP of patient with FH appeared normal in the initial stage for a long time, after that,elevated in part of the cases gradually; however, once the intraocular pressure elevated, it often appeared persistently higher, although there maybe some fluctuations. The elevated IOP and KP in patient with FH had no characteristic of intermittent, were difficult to be controlled and poorly responded to corticosteroids therapy.

IOP in patients with PSS complicated with iris heterochromatic kept the characteristic of crossed-over, that is, the IOP of the attacked eye was higher than that of contra lateral eye during the episode but lower(3 ~ 5mmHg) than the other eye between attacks. IOP in patients with Fuchs syndrome had no such characteristic, once elevated; it is always higher if untreated.

**Figure 20.** Typical clinical data of patient (Clinical number: 437614) with diagnosis of right PSS combined iris disorder. The right eye is after Ahmed implantation and arrow indicate iris heterochromia (A), the left eye is normal (B). UBM indicate a wild angle in right eye(C), but the visual field show serious damages in right eye (D).

**4.2. PSS combined with ischemic optic neuropathy**

The patients came to our hospital because her vision of the left eye sudden dropped 2 months ago. She was examined 2 months ago: visual acuity: 1.0/ 0.5(R/L) IOP: 17.3/ 15(R/L) mmHg. The optic disc of her left eye was pale , visual field showed an inferior fan like defect. Fundus fluorescein angiography( FFA) of her left eye showed ischemic optic neuropathy. the anterior segment, fundus, vision, and FFA of her right eye were normal. She was diagnosed as "left eye ischemic optic neuropathy". She was admitted to our hospital, and examinations showed: visual acuity: 1.0/ 0.15(R/L). IOP: 17.3/ 50.62(R/L), anterior chamber of both eyes were not shallow, Right eye showed no abnormality. Left cornea was mild edema and there was a medium size fat-like KP below the pupil. The boundary of optic papillae in left eye was clear, the color was off white, and the C / D was about 0.3,the angle of left eye was N1 ~ N2. Systemic examination such as X-ray, electrocardiogram and routine laboratory tests were normal. Visual field of right eye was normal and that of the left eye showed a centripetal narrow whit an inferior fan like defect. She was diagnosed as "Left eye PSS,complicated with ischemic optic neuropathy", and treated with drugs for reducing IOP and nutrition curing to optic nerve for about a weak. She was discharged with IOP 12mmHg disappeared KP, vision 0.2 of her left

**Figure 21.** Heterochromatic iris and KP in FHI. There is a typical iris such as "rain dozen sand -like" (A) arrow shows a

Clinical Research Progress of Glaucomatocyclitic Crisis

http://dx.doi.org/10.5772/54335

413

In 2003 1 case of PSS complicated with nonarteritic anterior ischemic optic neuropathy (AION) was reportd. The vision of the case improved significantly after the attack of PSS had been controlled, but the vision and optic neuropathy damaged continually. The authors emphasized that the IOP of PSS patients complicated with AION should be promptly controlled as it is risk

**Typical cases**

lot of star-like pigmented KPs (B).

eye. (Clinical data see Figure 22)

**Discussion**

#### **KP**

The KP in patient with PSS complicated with iris heterochromia appeared only in a short period during the attack in most cases. This KP is of following characteristics: small round suet-like, medium sized, isolated, with no pigment in initial stage, mainly located in the lower part of the cornea, usually disappeared naturally within a few days after or before IOP reduction. On the contrary, KP in patients with Fuchs syndrome has different characteristics as following: persistence for very long time even always in most cases, white transparent small dot or starlike coexisting with pigmented KP, diffuse distribution in the cornea, sometimes connected each other with fibrous filaments, poor response to corticosteroids therapy. (Clinical data see Figure 21)

#### **Lens situation**

Fuchs syndrome complicated with cataract is common at later stage; however the complicated cataract is uncommon in the PSS cases with iris heterochromia.

#### **Glaucomatous retinal and visual damage**

Glaucomatous damage in PSS cases appeared later and to a lesser extent, however that of FHI cases occur earlier and quicker.

**Figure 21.** Heterochromatic iris and KP in FHI. There is a typical iris such as "rain dozen sand -like" (A) arrow shows a lot of star-like pigmented KPs (B).

#### **4.2. PSS combined with ischemic optic neuropathy**

#### **Typical cases**

**KP**

412 Glaucoma - Basic and Clinical Aspects

Figure 21)

**Lens situation**

The KP in patient with PSS complicated with iris heterochromia appeared only in a short period during the attack in most cases. This KP is of following characteristics: small round suet-like, medium sized, isolated, with no pigment in initial stage, mainly located in the lower part of the cornea, usually disappeared naturally within a few days after or before IOP reduction. On the contrary, KP in patients with Fuchs syndrome has different characteristics as following: persistence for very long time even always in most cases, white transparent small dot or starlike coexisting with pigmented KP, diffuse distribution in the cornea, sometimes connected each other with fibrous filaments, poor response to corticosteroids therapy. (Clinical data see

**Figure 20.** Typical clinical data of patient (Clinical number: 437614) with diagnosis of right PSS combined iris disorder. The right eye is after Ahmed implantation and arrow indicate iris heterochromia (A), the left eye is normal (B). UBM

indicate a wild angle in right eye(C), but the visual field show serious damages in right eye (D).

Fuchs syndrome complicated with cataract is common at later stage; however the complicated

Glaucomatous damage in PSS cases appeared later and to a lesser extent, however that of FHI

cataract is uncommon in the PSS cases with iris heterochromia.

**Glaucomatous retinal and visual damage**

cases occur earlier and quicker.

The patients came to our hospital because her vision of the left eye sudden dropped 2 months ago. She was examined 2 months ago: visual acuity: 1.0/ 0.5(R/L) IOP: 17.3/ 15(R/L) mmHg. The optic disc of her left eye was pale , visual field showed an inferior fan like defect. Fundus fluorescein angiography( FFA) of her left eye showed ischemic optic neuropathy. the anterior segment, fundus, vision, and FFA of her right eye were normal. She was diagnosed as "left eye ischemic optic neuropathy". She was admitted to our hospital, and examinations showed: visual acuity: 1.0/ 0.15(R/L). IOP: 17.3/ 50.62(R/L), anterior chamber of both eyes were not shallow, Right eye showed no abnormality. Left cornea was mild edema and there was a medium size fat-like KP below the pupil. The boundary of optic papillae in left eye was clear, the color was off white, and the C / D was about 0.3,the angle of left eye was N1 ~ N2. Systemic examination such as X-ray, electrocardiogram and routine laboratory tests were normal. Visual field of right eye was normal and that of the left eye showed a centripetal narrow whit an inferior fan like defect. She was diagnosed as "Left eye PSS,complicated with ischemic optic neuropathy", and treated with drugs for reducing IOP and nutrition curing to optic nerve for about a weak. She was discharged with IOP 12mmHg disappeared KP, vision 0.2 of her left eye. (Clinical data see Figure 22)

#### **Discussion**

In 2003 1 case of PSS complicated with nonarteritic anterior ischemic optic neuropathy (AION) was reportd. The vision of the case improved significantly after the attack of PSS had been controlled, but the vision and optic neuropathy damaged continually. The authors emphasized that the IOP of PSS patients complicated with AION should be promptly controlled as it is risk

**4.4. PSS combined with cataract**

o.4.Her left eye appeared normal.

(Clinical data see Figure 23)

**5. Discussion**

cataract.

She complained of recurrent pain and decreased vision of her right eye for four years.

Results of examinations intraday showed: visual acuity:0.08/ 0.4(R/L); corrected visual acuity R:0.3(-0.75DS/1.50DC\*111),L: 0.9(-1.25DS/-0.50DC\*83 ) ;IOP: 12/ 14(R/L) mmHg; a few of timeworn pigmented KP on the central and lower part of her clear corneal; round pupil about 3mm in diameter; normal iris , opacification of posterior capsule of len; C/D of optic papillae

Clinical Research Progress of Glaucomatocyclitic Crisis

http://dx.doi.org/10.5772/54335

415

She was hospitalized with the diagnosis of PSS and was treated with carteolol, brimonidine, mannitol for reducing IOP, tobradex for anti-inflammation and methycobal to maintain optic nerve. She was discharged once the attack of PSS faded away every time.The PSS attacked her 1 to 2 month a time, her vision of right eye declined gradually without other discomfort.

**Figure 23.** Anterior segment slit-lamp photography of patient (Clinical number: 394998) with the diagnosis of PSS combined with cataract. Arrows show an opacities area at posterior capsule (A) and few typical fat-shaped KPs (B).

The possible pathogenesis: repeated onset of IOP elevation and anterior segment inflammation

Surgical opportunity: Cataract surgery should be done after the inflammation has been subsidized for more than 3 months. The rest of the indication is the same to the conventional

cause disorders of nutrition and metabolism of the lens.

**Typical cases**

**Figure 22.** Visual field of patient (Clinical number: 294450) The case suffered from left eye PSS combined with ischemic optic neuropathy. Inferior Visual field defect and serious contraction of left (A),and that of the normal right eye (B).

factors [41]. It is useful to use drugs with dual role of reducing IOP and improving retinal blood supply in intermittent period.

Our case appeared a sudden vision loss and significant discomfort two months ago. The result of examinations in other hospital such as visual field defect of arcuate below and FFA supported the diagnosis of left eye ischemic optic neuropathy. Results of examinations, reaction to treatment and course of the disease during her hospitalization in our hospital In July 2000 conformed with diagnostic criteria of PSS. The structure of the optic nerve , damage of blood vessels and blood state are related to ischemic optic neuropathy, the severely sudden rising of IOP during attack of PSS maybe the inducing factors. So it is necessary to reduce the IOP during each attack of PSS as soon and effective as possible for the cases of PSS combined with ischemic optic neuropathy or with the risk factors for that.

#### **4.3. PSS combined with rhegmatogenous retinal detachment**

#### **Typical cases**

He was hospitalized in our hospital for the reason that there was shadow before his right eye with a diagnose of rhegmatogenous retinal detachment.

The IOP of his right eye elevated to 29 mmHg 3 days after hospitalization and a fat-like KP appeared in his right eye, than he was diagnosed as rhegmatogenous retinal detachment combined with PSS. Retinal detachment surgery (Condensation + cerclage + scleral pressure technique) were done after reducing IOP with the treatment of drugs.Postoperative recovery was good. PSS recurrenced 4 months later and recovered 5 days late.

#### **Discussion**

The pathogenesis of PSS combined with rhegmatogenous retinal detachment is unknown. Increased concentration of PG (especially PGE) resulted from retinal S-antigen entered into the vitreous cavity after blood-eye barrier breakdown during the formation of retinal breaks may leads to the inflammation of the uvea, and the higher concentration of PGs and inflam‐ matory products results in the IOP elevation.

#### **4.4. PSS combined with cataract**

#### **Typical cases**

factors [41]. It is useful to use drugs with dual role of reducing IOP and improving retinal blood

**Figure 22.** Visual field of patient (Clinical number: 294450) The case suffered from left eye PSS combined with ischemic optic neuropathy. Inferior Visual field defect and serious contraction of left (A),and that of the normal

Our case appeared a sudden vision loss and significant discomfort two months ago. The result of examinations in other hospital such as visual field defect of arcuate below and FFA supported the diagnosis of left eye ischemic optic neuropathy. Results of examinations, reaction to treatment and course of the disease during her hospitalization in our hospital In July 2000 conformed with diagnostic criteria of PSS. The structure of the optic nerve , damage of blood vessels and blood state are related to ischemic optic neuropathy, the severely sudden rising of IOP during attack of PSS maybe the inducing factors. So it is necessary to reduce the IOP during each attack of PSS as soon and effective as possible for the cases of PSS combined

He was hospitalized in our hospital for the reason that there was shadow before his right eye

The IOP of his right eye elevated to 29 mmHg 3 days after hospitalization and a fat-like KP appeared in his right eye, than he was diagnosed as rhegmatogenous retinal detachment combined with PSS. Retinal detachment surgery (Condensation + cerclage + scleral pressure technique) were done after reducing IOP with the treatment of drugs.Postoperative recovery

The pathogenesis of PSS combined with rhegmatogenous retinal detachment is unknown. Increased concentration of PG (especially PGE) resulted from retinal S-antigen entered into the vitreous cavity after blood-eye barrier breakdown during the formation of retinal breaks may leads to the inflammation of the uvea, and the higher concentration of PGs and inflam‐

with ischemic optic neuropathy or with the risk factors for that.

**4.3. PSS combined with rhegmatogenous retinal detachment**

was good. PSS recurrenced 4 months later and recovered 5 days late.

with a diagnose of rhegmatogenous retinal detachment.

matory products results in the IOP elevation.

supply in intermittent period.

414 Glaucoma - Basic and Clinical Aspects

**Typical cases**

right eye (B).

**Discussion**

She complained of recurrent pain and decreased vision of her right eye for four years.

Results of examinations intraday showed: visual acuity:0.08/ 0.4(R/L); corrected visual acuity R:0.3(-0.75DS/1.50DC\*111),L: 0.9(-1.25DS/-0.50DC\*83 ) ;IOP: 12/ 14(R/L) mmHg; a few of timeworn pigmented KP on the central and lower part of her clear corneal; round pupil about 3mm in diameter; normal iris , opacification of posterior capsule of len; C/D of optic papillae o.4.Her left eye appeared normal.

She was hospitalized with the diagnosis of PSS and was treated with carteolol, brimonidine, mannitol for reducing IOP, tobradex for anti-inflammation and methycobal to maintain optic nerve. She was discharged once the attack of PSS faded away every time.The PSS attacked her 1 to 2 month a time, her vision of right eye declined gradually without other discomfort. (Clinical data see Figure 23)

**Figure 23.** Anterior segment slit-lamp photography of patient (Clinical number: 394998) with the diagnosis of PSS combined with cataract. Arrows show an opacities area at posterior capsule (A) and few typical fat-shaped KPs (B).
