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76-year-old female patient, with past medical history of relapsing-remitting multiple sclerosis manifested by retrobulbar optic neuritis in both eyes with an interval of one year between the first episode in the left eye and the one in the right eye and after three decades of remission, who consulted due to bilateral blurred and foggy vision. Subsequently, several differential diagnoses where ruled out. Diagnosis of bilateral anterior and intermediate uveitis with occlusive vasculitis attributed to a new relapse episode of multiple sclerosis was made, as the association between multiple sclerosis and intermediate uveitis is known, though the causal association is still questioned. This case shows how multiple sclerosis may only manifest with ocular involvement and exemplifies the broad spectrum of manifestations and complications, taking into account that ischemic areas from vasculitis and other comorbidities led to macular edema and unfortunately, prognosis became poorer. The complex course of the case enables emphasizing the responsibility role of the ophthalmologists in such systemic entities that may compromise the eye, in which suspicion of the disease and an adequate timing management approach is essential.

A bstract Aim and objective To present a case of bilateral delayed-onset hyphema following the administration of a 1% tropicamide and 2.5% phenylephrine fixed combination ophthalmic agent, in the late follow-up period of a gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract extraction. Background Gonioscopy-assisted transluminal trabeculotomy consists on a 360° trabeculotomy through an ab interno approach that may also be combined with cataract surgery. Delayed-onset hyphema has been reported with trabecular minimally invasive glaucoma surgery (MIGS) procedures. Some proposed mechanisms are ocular compression and decompression during sleeping on the surgical side and episcleral venous pressure rise after physical activity. Case description We describe the case of a 68-year-old female patient with ocular hypertension (OHT) and bilateral cataracts who underwent uncomplicated combined GATT and cataract extraction surgery. Postoperatively, 8 months after the left eye (OS) surgery and 3 months after the right eye (OD) surgery, patient came for routine evaluation. After induced mydriasis, slit-lamp evaluation revealed the presence of 3+ OD and 4+ OS erythrocytes in the anterior chamber (AC). Prednisolone acetate was prescribed q.i.d. and remission of hyphema was achieved after 2 weeks. Subsequently, 4 months later, the pupil dilation was again induced showing 4+ erythrocytes in both eyes (OU), layered hyphema in the inferior quadrant OS, and intraocular pressure (IOP) spike OU. The intraocular pressure was controlled after oral acetazolamide was prescribed. Topic prednisolone was initiated, and after 1 week, the hyphema was resolved in OU. Conclusion Delayed-onset microhyphema may occur following induced mydriasis even months after the uncomplicated GATT procedure. Ophthalmologists should be aware of the possibility of microhyphema after induced mydriasis and the risks that this might represent with noteworthy and repeated IOP spikes which may eventually require treatment. Clinical significance Delayed-onset hyphema and IOP spikes may occur following the pupil dilation with fixed combination of phenylephrine and tropicamide ophthalmic agent after the uncomplicated GATT procedure. How to cite this article Espinoza G, Rodriguez-Una I, Pedraza-Concha A. A Case of Bilateral Delayed-onset Hyphema Following Pupil Dilation after Gonioscopy-assisted Transluminal Trabeculotomy. J Curr Glaucoma Pract 2020;14(2):72–75.

AIM: To describe the safety and efficacy of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in primary open angle glaucoma (POAG) and ocular hypertension (OHT) after 18-month follow-up in Hispanic population. METHODS: A single-center, retrospective study was conducted. All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study. Investigated parameters were intraocular pressure (IOP), the number of IOP-lowering medications, best corrected visual acuity (BCVA), laser parameters and postoperative adverse events. Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction ≥20% at 18mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values. RESULTS: From 40 PLT-treated eyes (mean baseline IOP 20.3±1.7 mm Hg), 24 patients were analyzed (age 63.4±7.3y). The mean IOP reductions from baseline across visits (months 1, 3, 6, 9, 12, and 18) ranged from 14.1% to 20.8%. Success rate after 18-month follow-up was 61.7% with a mean IOP of 16±3.2 mm Hg (P<0.001). The number of glaucoma IOP-lowering medications per eye (preoperative 2.1±1.1 and postoperative 2.3±1.1, P=0.86) and the mean BCVA (preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR, P=0.42) remained stable. Adverse events comprised transitory IOP spikes in 4 eyes (10%) and peripheral anterior synechiae in 7 eyes (17.5%). CONCLUSION: Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.

Aim.To analyze clinical features, treatment, and results of patients with non-penetrating traumatic hyphema in an ophthalmological center in Colombia. Methods. A retrospective cohort study in which medical records of patients with traumatic hyphema were analyzed between 2013 and 2018. Results. 38 eyes of 37 patients (34 men, 3 women) were included. Average age was 30.6 ± 16.6 years. Sports-related (42.1%) and occupational accidents (34.2%) were the main causes. 67.5% of the eyes had grade I hyphema. 95% received topical corticosteroids, 92.1% topical mydriatics and 52.63% ocular hypotensive eyedrops. Two eyes with hyphema grade I did not receive steroids and resolved uneventfully. None of the eyes rebleeded, even without antifibrinolytics. One patient with grade IV hyphema required surgery. Mean hyphema's clearance time was 8.4 ± 3.2 days. The last mean corrected distance visual acuity was LogMAR 0.25. There were no complications directly related to the hyphema. Conclusions. Working related activities were the second cause of traumatic hyphema in our cohort, which might be attributable to poor awareness of the importance or ocular protection, or limited access to recommended protective devices. Outpatient management enabled adequate outcomes. Corticosteroids and mydriatics were the treatment cornerstone, though seemed not to be imperative when hyphema was grade I. We were not able to support the contributive role from antifibrinolytics, because none of our patients rebleeded in spite of the absence of them.