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Open Access Screening of intraocular pressure before routine pupil dilation for retinal photography: Clinical case report

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Introduction: Pharmacologic dilation of the pupil results in twice the sensitivity of detection of diabetic retinopathy compared with undilated retinal examination. The potential risk of acute angle-closure glaucoma after pupil dilation has been hypothesized to be higher in Asian patients with diabetes mellitus.

Clinical case: A 61-year-old man with diabetes mellitus and hypertension was incidentally found to have elevated intraocular pressure (IOP) before routine retinal photography. He was asymptomatic and the visual acuity was 0.67 for both eyes. An ophthalmologist later found he had anatomical narrow-angle borderline glaucoma. Topical administration of pilocarpine and oral administration of acetazolamide were initiated, and laser iridotomy was later performed.

IOP screening: Among 1736 diabetic and/or hypertensive patients who underwent IOP screening, 31 patients (1.8%) had IOP of any eye persistently higher than 21 mm Hg on at least two occasions. The mean (standard deviation) IOP of the right eye was 24.1 (2.1) mm Hg, while that of the left eye was 24.6 (2.5) mm Hg. Four patients (12.9%) were found to have glaucoma, and treatment was initiated by an ophthalmologist. Therefore further study should be conducted to evaluate the cost-effectiveness of IOP screening among this group of patients.
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Keywords: Glaucoma; intraocular pressure; screening

Document Type: Research Article

Publication date: 2016-12-01

More about this publication?
  • Family Medicine and Community Health (FMCH) is an open-access journal focusing on subjects that are common and relevant to family medicine/general practice and community health. The journal publishes relevant content across disciplines such as epidemiology, public health, social and preventive medicine, research and evidence based medicine, community health service, patient education and health promotion and health ethics. The journal has a specific focus on the management of chronic illness particularly diabetes, ischaemic heart disease, chronic heart failure, hypertension, bronchial asthma, chronic obstructive airways disease and common mental illness. FMCH is published by Compuscript http://www.compuscript.com on behalf of the Chinese General Practice Press http://www.chinagp.net.

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