قاسم فخرایی

To report a rare presentation of ophthalmic tuberculosis.

 A 19-year-old man was referred to the glaucoma clinic due to multiple attacks of increased intraocular pressure (IOP) in his right eye. IOP of the right eye was 50 mmHg, and glaucomatous damage of the optic nerve was present. In gonioscopy, an oval-black lesion was present in the ciliary body band on the temporal side, which looked like a granuloma in ultrasound biomicroscopy (UBM). After rejecting immunological diseases due to the 20mm tuberculin test, the diagnosis of ciliary body tuberculosis was made. The patient was treated with a multi-drug regimen for 9 months. After 4 weeks, IOP was normalized, and at the end of 9 months, the ciliary body granuloma disappeared.

Ciliary body tuberculosis can cause multiple attacks of acute IOP rise (possibly due to the release of pigment and necrotic debris). Systemic causes of glaucoma such as tuberculosis should be kept in mind, especially in unilateral cases, and performing a thorough gonioscopy is useful in this regard.

Studies in the recent years have shown that corneal astigmatism changes occur after trabeculectomy and emphasis on steeping of vertical meridian and inducing With the Rule Astigmatism (WTR) have regulations. The present study was conducted to study the changes in rate astigmatism and its axis, myopia, and hypermetropia in trabeculectomy and shunt surgery.

In the present comprative study, two groups of 16 patients with average age of 52.4±8.9 and 94.6±6.7 respectively under trabeculetomy and shunt surgery were recruited. They were studied and compared for changes of refractive error before, 1 week, 1 month, and 3 months after surgery. Data were analyzed using Friedman and Mann-whitney tests.

Averages of Intraocular Pressure (IOP) before, 1 week, 1 month, and 3 were 31.31±7.6, 9.8±2.8, 10.5±1.29, 10.9±1.26 (P<0.05) months after trabeculectomy and 36.06±10.32, 13.5±3.3, 11.68±2.21, 11.18±1.27(P<0.05) after shunt. Also, averages of astigmatism were -1.00±0.59, -6.00±1.9, -2.21±1.18, -1.37±0.62 (P<0.05) in trabeculectomy and -0.89±0.46, -1.56±1.62, -1.51±1.46, -1.07±0.85(P>0.05) in shunt. The percentages of WRT astigmatism in trabeculectomy were 37.5, 100, 37.5, 31.25 and these values in shunt were 43.75, 50, 50, 56.25. In addition, the averages of Equivalane sphere (Es) in trabeculectomy were -0.31±1.49, 1.43±1.94, 0.27±1.74, 0.04±1.46(P<0.05), whereas these values were 0.65±1.5, 1.03±2.03, -.70±1.64, 0.62±1.54 (P<0.05) in shunt. Comparison of astigmatism and axial between trabeculectomy and shunt using Mann-whitney test showed significant changes (P<0.05), but Es was not found to be significantly different (P>0.05).

Both surgery methods induced hypermetropia which decrease with time, but the amount of astigmatism and percentage of WTR astigmatism in trabeculectomy were more than those for shunt surgery.