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Argon Laser Photocoagulation for Macular Edema in Branch Vein Occlusion
218
February, 1985
AMERICAN JOURNAL OF OPHTHALMOLOGY
there was no mention of the intraocular pressures, anterior chamber depths, or gonioscopic appearances in any of the seven cases reported. Intermittent angle-closure glaucoma with mydriasis can mimic migraine as the following case history exemplifies. A 31-year-old man reported an IS-month history of episodic periorbital headache. The pain was severe and lasted up to three hours. During an attack the vision in his left eye became blurred, and occasionally he noticed haloes arourid lights. On three occasions the patient noted his left pupil dilating during the attack. Often the headaches were precipitated by stress and accompanied by nausea. Propranolol prescribed for migraine relieved the headache promptly and the vision recovered completely. Visual acuity was 20/16 in both eyes. Visual fields were full. The left pupil measured 6 mm and the right 4 mm. A sector palsy in the upper nasal quadrant of the left iris was evident on slit-lamp examination. Intraocular pressure was 16 mm Hg in both eyes and gonioscopy showed a narrow angle with a plateau-type iris. Dilating the pupils with tropicamide did not increase the intraocular pressure. The patient was asked to return promptly if he developed headache. When he was seen during an attack intraocular pressure in his left eye was 26 min Hg, but he had taken 40 mg of propranolol for the pain. Two days later a provocative dark-room test was performed, and although this was initially negative, six hours later typical headache developed and the patient was found to have an intraocular pressure of 45 mm Hg and a closed angle on gonioscopy. He underwent bilateral peripheral iridectomies and subsequent progress has been uneventful. We believe that ophthalmologists should exclude episodic angle-closure glaucoma in a patient with a history of periorbital headache associated with unilateral mydriasis. N. J. e. SARKIES, M.R.C.P., F.R.e.S. M. D. SANDERS, F.R.e.P., F.R.e.S. P. e. GAUTIER-SMITH, M:D., F.R.C.P.
London, England
_ _ _ _ _ _ _ Reply
_
EDITOR:
We agree completely with Drs. Sarkies, Sanders, and Gautier-Smith's observation that ophthalmologists should exclude episodic angle-closure glaucoma in a patient with a history of periorbital headache associated with unilateral mydriasis. Six of our seven patients were examined during episodes
of mydriasis and headache and all were found to have normal vision, as we reported in our article. Although not specifically mentioned, the anterior chamber angle was open and the intraocular pressures normal in each of these cases during the event. We assumed that the statement "other findings were normal" would be sufficient. DONALD WOODS, M.D.
Homestead, Florida PATRICK 5. O'CONNOR, M.D.
San Antonio, Texas RICHARD FLEMING, M.D.
Seguin, Texas
Argon Laser Photocoagulation Edema In Branch Vein
for Macular Occlusion
EDITOR:
The article, "Argon laser photocoagulation for macular edema in branch vein occlusion" (Am. J. Ophthalmol. 98:271, September 1984), by the Branch Vein Occlusion Study Group, is an important contribution to the problem of macular edema. In reading the article, several questions came to mind that are of importance to us in clinical practice. What was the exact technique used for treatment? The spot size and the usual power settings were not mentioned in the article. What was the extent of visual field loss experienced by these patients? Was there a limit to the area of edema that was treated? It appears from the protocol that some patients could have been treated for the entire posterior pole, perhaps causing substantial visual field loss that would be more distressing than the decrease in visual acuity. Was treatment in the maculopapular bundle done, and, if so, was there any decrease in visual acuity attributable to this treatment? It is certainly valuable to know that over the long term, there is benefit from such treatment; however, what is the mechanism for this improvement? The reason this is important is that one could assume that any retinal capillary leakage could be treated by this method; thus the study lends support to grid treatment for cystoid macular edema, diabetic macular edema, and macular edema from any cause creating retinal capillary leakage. STEPHEN D. MILLER, M.D.
Honolulu, Hawaii
February, 1985
AMERICAN JOURNAL OF OPHTHALMOLOGY
there was no mention of the intraocular pressures, anterior chamber depths, or gonioscopic appearances in any of the seven cases reported. Intermittent angle-closure glaucoma with mydriasis can mimic migraine as the following case history exemplifies. A 31-year-old man reported an IS-month history of episodic periorbital headache. The pain was severe and lasted up to three hours. During an attack the vision in his left eye became blurred, and occasionally he noticed haloes arourid lights. On three occasions the patient noted his left pupil dilating during the attack. Often the headaches were precipitated by stress and accompanied by nausea. Propranolol prescribed for migraine relieved the headache promptly and the vision recovered completely. Visual acuity was 20/16 in both eyes. Visual fields were full. The left pupil measured 6 mm and the right 4 mm. A sector palsy in the upper nasal quadrant of the left iris was evident on slit-lamp examination. Intraocular pressure was 16 mm Hg in both eyes and gonioscopy showed a narrow angle with a plateau-type iris. Dilating the pupils with tropicamide did not increase the intraocular pressure. The patient was asked to return promptly if he developed headache. When he was seen during an attack intraocular pressure in his left eye was 26 min Hg, but he had taken 40 mg of propranolol for the pain. Two days later a provocative dark-room test was performed, and although this was initially negative, six hours later typical headache developed and the patient was found to have an intraocular pressure of 45 mm Hg and a closed angle on gonioscopy. He underwent bilateral peripheral iridectomies and subsequent progress has been uneventful. We believe that ophthalmologists should exclude episodic angle-closure glaucoma in a patient with a history of periorbital headache associated with unilateral mydriasis. N. J. e. SARKIES, M.R.C.P., F.R.e.S. M. D. SANDERS, F.R.e.P., F.R.e.S. P. e. GAUTIER-SMITH, M:D., F.R.C.P.
London, England
_ _ _ _ _ _ _ Reply
_
EDITOR:
We agree completely with Drs. Sarkies, Sanders, and Gautier-Smith's observation that ophthalmologists should exclude episodic angle-closure glaucoma in a patient with a history of periorbital headache associated with unilateral mydriasis. Six of our seven patients were examined during episodes
of mydriasis and headache and all were found to have normal vision, as we reported in our article. Although not specifically mentioned, the anterior chamber angle was open and the intraocular pressures normal in each of these cases during the event. We assumed that the statement "other findings were normal" would be sufficient. DONALD WOODS, M.D.
Homestead, Florida PATRICK 5. O'CONNOR, M.D.
San Antonio, Texas RICHARD FLEMING, M.D.
Seguin, Texas
Argon Laser Photocoagulation Edema In Branch Vein
for Macular Occlusion
EDITOR:
The article, "Argon laser photocoagulation for macular edema in branch vein occlusion" (Am. J. Ophthalmol. 98:271, September 1984), by the Branch Vein Occlusion Study Group, is an important contribution to the problem of macular edema. In reading the article, several questions came to mind that are of importance to us in clinical practice. What was the exact technique used for treatment? The spot size and the usual power settings were not mentioned in the article. What was the extent of visual field loss experienced by these patients? Was there a limit to the area of edema that was treated? It appears from the protocol that some patients could have been treated for the entire posterior pole, perhaps causing substantial visual field loss that would be more distressing than the decrease in visual acuity. Was treatment in the maculopapular bundle done, and, if so, was there any decrease in visual acuity attributable to this treatment? It is certainly valuable to know that over the long term, there is benefit from such treatment; however, what is the mechanism for this improvement? The reason this is important is that one could assume that any retinal capillary leakage could be treated by this method; thus the study lends support to grid treatment for cystoid macular edema, diabetic macular edema, and macular edema from any cause creating retinal capillary leakage. STEPHEN D. MILLER, M.D.
Honolulu, Hawaii