Manayath George Joseph, Ranjan Ratnesh, Khare Shubhank, Vidhate Swapnil, Venkatapathy Narendran
Department of Vitreo-Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.
Oman J Ophthalmol. 2022 Jun 29;15(2):208-211. doi: 10.4103/ojo.ojo_319_21. eCollection 2022 May-Aug.
A 39-year-old man, a known case of primary open-angle glaucoma on treatment, presented with defective central vision in the left eye. On examination, his intraocular pressure (IOP) was 26 mmHg in the right eye and 30 mmHg in the left eye with best-corrected visual acuity of 6/12 in each eye. Fundus examination showed glaucomatous optic neuropathy in both eyes and macular thickening in the left eye. Optical coherence tomography of the left eye showed macular detachment with peripapillary retinoschisis and a hyporeflective tract connecting schitic retina and the deep cup in the absence of an optic disc pit. A diagnosis of glaucomatous deep cup maculopathy (DCM) was made in the left eye, which persisted despite well-controlled IOP and peripapillary laser photocoagulation. The addition of oral acetazolamide (250 mg twice daily) to his regimen resulted in prompt resolution of maculopathy. Glaucomatous DCM is relatively rare, and its primary management is adequate IOP control with antiglaucoma medications. Including oral acetazolamide in the antiglaucoma regimen can help in faster resolution of maculopathy due to its additional effect on retinal pigment epithelial pump induction and stabilization of the pressure gradient.
一名39岁男性，已知患有原发性开角型青光眼且正在接受治疗，因左眼中心视力缺陷前来就诊。检查发现，他右眼眼压（IOP）为26 mmHg，左眼眼压为30 mmHg，每只眼睛的最佳矫正视力均为6/12。眼底检查显示双眼均有青光眼性视神经病变，左眼黄斑增厚。左眼光学相干断层扫描显示黄斑脱离伴视乳头周围视网膜劈裂，以及在没有视盘凹陷的情况下连接劈裂视网膜和深杯的低反射带。左眼被诊断为青光眼性深杯黄斑病变（DCM），尽管眼压得到良好控制且进行了视乳头周围激光光凝治疗，但该病变仍持续存在。在他的治疗方案中加用口服乙酰唑胺（每日两次，每次250 mg）后，黄斑病变迅速消退。青光眼性DCM相对罕见，其主要治疗方法是使用抗青光眼药物充分控制眼压。在抗青光眼治疗方案中加入口服乙酰唑胺有助于黄斑病变更快消退，因为它对视网膜色素上皮泵诱导和压力梯度稳定有额外作用。
