AN ULTRASOUND BIOMICROSCOPIC ANALYSIS OF ANGLE-CLOSURE GLAUCOMA SECONDARY TO CILIOCHOROIDAL EFFUSION IN IGA NEPHROPATHY

Immunoglobulin A nephropathy is a common glomerulonephritis of unknown cause. Episcleritis, scleritis, anterior uveitis, and keratoconjunctivitis sicca have been associated with this disease. We diagnosed angle-closure glaucoma secondary to ciliochoroidal effusion in a patient with IgA nephropathy confirmed by biopsy. High-frequency ultrasound biomicroscopy was used to determine internal relationships of angle structures and to follow changes with treatment. Supraciliary effusion undetected by B-scan ultrasound and retinal examination was easily imaged by ultrasound biomicroscopy. Glaucoma mechanisms included forward rotation of the ciliary processes, which caused direct angle closure in a manner similar to plateau iris. Ultrasound biomicroscopy showed that cycloplegia improved this mechanism by retracting the ciliary processes, but angle closure secondary to forward iris bowing from pupil block remained. Iridectomy was performed and immediately opened the angle. Ultrasound biomicroscopy proved a useful method of defining mechanisms and a helpful guide to treatment in this type of glaucoma.