Acute Angle-Closure Glaucoma in a Patient With Miller Fisher Syndrome Without Pupillary Dysfunction

Ryu, Won Yeol; Kim, Jong Kuk; Jin, Sang Wook; Shim, Dong Hyun

doi:10.1097/ijg.0000000000000191

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…[ 2 ] MFS patients with acute angle closure glaucoma have been reported, and most of them were related to ocular autonomic nerve involvement. [ 3 – 5 ] In this report, it was extremely rare that ophthalmoplegia, ataxia, and loss of tendon reflex did not appear in the early stage of MFS, but mydriasis and elevated intraocular pressure were the main manifestations. The first diagnosis was difficult, and the order of involvement of the oculomotor nerve, trochlear nerve, abducens nerve, and ciliary ganglion enriched with GQ1b ganglioside were considered.…”

Section: Discussionmentioning

confidence: 74%

“…[ 1 ] Pupil abnormality caused by autonomic nerve involvement account for about 33.7% of MFS. [ 2 ] It has been reported that acute angle closure glaucoma could occur due to autonomic nerve involvement in the course of MFS, [ 3 – 5 ] but there were no reports of acute angle-closure glaucoma as the first manifestation of the MFS. In this paper, we present a case of MFS with acute angle-closure glaucoma as the first manifestation.…”

Section: Introductionmentioning

confidence: 99%

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Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation

Han

Ji²,

Cao³

et al. 2017

Medicine

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Rationale:There were no reports of Miller Fisher syndrome (MFS) with acute angle-closure glaucoma as the first manifestation.Patient concerns:A 78-year-old female patient was admitted to our hospital with pain in her left eye, blurred vision along with nausea, and vomiting for 2 days. It was extremely rare that ophthalmoplegia, loss of tendon reflexes, and ataxia, did not occur in the early stages of MFS, and initial presentation was only dilated pupis and an increase in intraocular pressure.Diagnoses:The final diagnosis of the patient was MFS.Interventions:Intravenous immunoglobulins were administered.Outcomes:Ophthalmoplegia, walking instability, and ataxia gradually improved. At 3 months follow-up, there was no neurological deficit, and the patient could completely self-care.Lessons:This is the first report of MFS patient with acute angle closure glaucoma as the first manifestation. Consideration should be given to the possibility of incorporating autonomic nervous system dysfunction, or even MFS, in patients with acute angle-closure glaucoma in order to reduce missed diagnosis rate.

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Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation

Han

Ji²,

Cao³

et al. 2017

Medicine

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“…a slov. Oftal., 75, 2019, No.4 [18,120,51]. Naše 71letá pacientka byla rovněž v pásmu hypermetropie, axiální délka oka pravého oka byla 22,38 mm, levého oka 22,26 mm.…”

Section: Kazuistikaunclassified

Simultaneous Bilateral Acute Angle-Closure Glaucoma in Miller Fisher Syndrome

Štěpánková

Kinstova

Gažová

et al. 2019

CSO

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Purpose: To report a case of patient with Miller Fisher syndrome, complicated by simultaneous bilateral acute angle-closure glaucoma in her slightly (+1.5) hyperopic eyes. Methods: We present a case report of a 71-year-old female patient presenting with total ophthalmoplegia, areflexia, ataxia and bilateral acute angle-closure glaucoma. Results: The initial ocular examination revealed hand motion in the both eyes and oedematic corneas. Initial intraocular pressure was immeasurable high (measurment by Tonopen Avia). Measurement was possible after intravenous Mannitol 20 % infusion on both eyes as 54 and 56 mm Hg, respectively. Local medical therapy of pilocarpine, timolol, dorsolamide and dexamethasone improve intraocular pressure into normal limits within several hours. Prophylactic peripheral Nd-YAG laser iridotomy was performed on a both eyes two days later. Systemic treatment involved plasma exchange and rehabilitation program. Subsequent cataract surgery on both eyes with posterior capsule lens implantation improve the best corrected visual acuity on right eye from 0.5 to 1.0 and the left eye from 0.5 to 0.8, respectively. Intraocular pressure is within normal limits without any glaucoma therapy. Follow up period is three years. Conclusions: This is the second reported case of patient with Miller Fisher syndrome and simultaneous bilateral acute angle-closure glaucoma and the fifth reported case of Miller Fisher syndrome and acute angle-closure glaucoma. Treatment for both conditions made a very good recovery.

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“…Many clinical and immunologic studies have investigated MFS since the discovery of the anti-GQ1b-ganglioside antibody 145678910. However, few studies—and especially ones conducted by neuro-ophthalmologists—have systematically explored ocular motility, even though ophthalmoplegia is the most-common, disabling, and consistent finding in MFS.…”

Section: Introductionmentioning

confidence: 99%

Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome

et al. 2019

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Background and Purpose The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. Methods We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). Results Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group ( p <0.01), and comprised 63.6% and 21.4% females, respectively ( p =0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO ( p =0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. Conclusions The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.

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Acute Angle-Closure Glaucoma in a Patient With Miller Fisher Syndrome Without Pupillary Dysfunction

Abstract: This is the first reported case of a patient with MFS without autonomic dysfunction and AACG. We believe that pupillary dysfunction or lid ptosis due to neurological disorders may increase the possibility of AACG.

Cited by 4 publications

References 7 publications

Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation

Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation

Simultaneous Bilateral Acute Angle-Closure Glaucoma in Miller Fisher Syndrome

Pattern of Extraocular Muscle Involvements in Miller Fisher Syndrome

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