Conclusions: Avastin holds promise as a novel and benefi-cial treatment modality for patients with polypoidal choroi-dopathy. Subfoveal lesions in particular may benefit fromtreatment with Avastin, as PDT has potential to causesignificant central vision loss.

Poster 58

Bilateral Angle Closure Following Cataract ExtractionMegan Price, O.D., PCO/Seidenberg Protzko EyeAssociates, 103 Remington Circle, Havre De Grace,Maryland 21078

Background: Elevated intraocular pressures are fairly com-mon after cataract extraction and usually return to normalwithin 1 week. Etiologies include pupillary block, hyphema,pigment dispersion, inflammation, and retained viscoelasticmaterial. Other etiologies, such as failing bleb, pupillaryblock glaucoma, suprachoroidal hemorrhage, and malignantglaucoma, should be considered when pressures remainelevated.Case Summary: A 58-year-old white female presented toour office with the chief complaint of blurry vision in herleft eye for the past 4 months. She also complained ofincreased glare in both eyes for the last few months, espe-cially at night. The patient is being treated for hypertensionand hypothyroidism and has been an asthmatic for 20 years.

As a �7.50 hyperope, BCVAs were 20/25 O.D., 20/40O.S. Glare testing showed results of 20/50 O.D., 20/400O.S. Intraocular pressures at this time were 19 mmHg O.D.,19 O.S. Slit-lamp examination and dilated fundus examina-tion were unremarkable except for lens changes OU. Thepatient chose to proceed with cataract extraction, left eyefirst.

Cataract surgery was performed without complications.Intraocular pressures were 21 mmHg O.S., 1 day postoper-atively, and 38 mmHg O.D. A port release was performedO.D. Pressures were 32 mmHg OU at the next visit a fewdays later. Medical therapy was instilled. Pressures variedfrom 16 mmHg and 18 mmHg up to 54 mmHg and 42mmHg over the next month. After consultation with ourglaucoma surgeon, a capsulotomy was performed. Pressuresremained elevated. Gonioscopy revealed angle closureO.D.�O.S. DFE showed vertical elongation of the cupO.D., and a normal cup O.S. At that time, trabeculectomywas determined to be the best option for our patient.Conclusion: Our patient is presumed to have malignantglaucoma, or aqueous misdirection syndrome, causing sec-ondary angle closure. This is a very rare condition that canfollow filtering surgery, and less commonly, cataract extrac-tion. Our patient remained asymptomatic throughout thecourse. It is important for us to better understand thisdisease to help inform our patients and provide the mostappropriate, timely treatment.

Poster 59

New Technologies Enable Earlier Detection ofExudative Age-Related Macular DegenerationElizabeth Sanders, O.D., Diana Schectman, O.D.,Joseph Pizzimenti, O.D., and Jose Arnaeo, B.S., NovaSoutheastern University, College of Optometry, 3200South University Drive, Ft. Lauderdale, Florida 33328

Background: Age-related macular degeneration (AMD) isthe leading cause of legal blindness in the elderly. Approx-imately 80% of advanced AMD cases are due to choroidalneovascularization (CNV). Novel non-invasive technolo-gies can be used to monitor the progression (or stability) ofAMD. These instruments go beyond the conventionalAmsler grid and dilated fundus examination, enabling ear-lier detection of CNV.

Optical coherence tomography (OCT) allows the exam-iner to view cross-sectional retinal images with a 2�m to10�m resolution. CNV as viewed with OCT may appear asa redundant hyper-reflective area abutting the hyper-reflec-tive signal from the Bruch’s/RPE/choriocapillaris. Preferen-tial hyperacuity perimetry (PHP) uses Vernier stimuli todetect RPE elevations that cause perceived object locationsto be shifted from their actual locations, resulting in ahyperacuity defect. We present the case of a patient withsignificant hyperacuity perimetric defects and OCT findingsconsistent with CNV in the absence of ophthalmoscopicevidence of an underlying CNV membrane.Case Report: A 57-year-old white female presented withmild visual blur O.S. Her ocular history was significant fornon-exudative AMD OU, diagnosed 2 years prior. Best-corrected acuity was stable at 20/30 O.D., but decreasedO.S. to 20/70 from 20/50 two months prior. Fundus biomi-croscopy of both maculae were deemed to be flat and intactwith moderate drusen. There was no ophthalmoscopic evi-dence of CNV in either eye. Although PreView PHP dem-onstrated no significant hyperacuity defects O.D., a densehyperacuity defect in the superior nasal field (6o � 4o) wasnoted O.S. Macular OCT revealed a marginally thinnedsensory retina O.D., and a 40-�m serous retinal detachmentO.S., with a clearly defined hyper-reflective redundantlayer, suspected to be CNV, overlying the RPE layer. Thepatient was referred for fluorescein angiography, whichconfirmed the diagnosis of early exudative AMD O.S. Thepatient was scheduled for antiangiogenic treatment.Conclusions: Both OCT and PHP are valuable tools inAMD management, beneficial for their ability to accuratelydetect very early CNV in a non-invasive manner. Earlierdetection of CNV may result in more timely treatment andimproved visual outcomes.

294 Optometry, Vol 78, No 6, June 2007