Basketball competition. . .followed by blurred vision.

摘要

A 15-year-old male basketball player was seen in an emergency room for evaluation of non-painful bilateral acute-onset photophobia and loss of vision that occurred immediately following a vigorous contest. A 9-year history of correction for progressive myopia was given. On examination, elevated intraocular pressures (lOPs) greater than 40 mm Hg were measured in both eyes, associated with corneal epithelial edema and very deep and clear anterior chambers.The lOPs responded to topical glaucoma medications and returned to a normal range in 3 hours. Referral to a glaucoma service was recommended. When seen again in 2 and 5 days after taking continued topical timolol/ dorzolamide and latanoprost, lOPs less than 20 mm Hg were measured. On further examination, this boy was found to be slender and healthy, and possessed corrected visual acuities of 20/20 in both eyes with a refractive error of -9.00 diopters in the right eye and -10.50 diopters in the left eye. His corneas were clear with no endothelial cell pigment deposition.The corneal diameters were 12.8 mm in both eyes and corneal thicknesses were 548 pm in the right eye and 557 pm in the left eye. The anterior chambers remained deep and clear. The pupils were large and reactive to light with no relative afferent pupillary defect. The irides were brown and strikingly bowed posteriorly into a concave configuration. The irides transilluminated through peripheral radial defects (Figure). His lOPs were 22 mm Hg in the right eye and 21 mm Hg in the left eye. Gonioscopy confirmed wide angles and circumferential concave irides. The insertion of the iris in both eyes was posterior to a mildly pigmented ciliary body band of moderate width. The mid-to-posterior trabecular meshwork was densely pigmented circumferentially. Anterior and adjacent to Schwalbe's line, a dense-narrow deposition of pigment circumferentially was found (Choi's line) in the same position as the wavy pigment defect seen with the pseudoexfoliation syndrome (Sampaolesi's line). Laser peripheral iridotomy in both eyes was performed. This resulted in an immediate relief of the bowing in the irides, as indicated by the observed iridal movement anteriorly to become more linear.