Optic nerve pallor was noted along with a cup-to-disc ratio of 0.8 in the left eye. Funduscopic examination demonstrated pigmented laser scars in the inferior periphery of the right eye and for 360 degrees throughout the periphery and encircling the posterior inferonasal break in the left eye. His retinae remained attached bilaterally. Over the subsequent eight months, progressive visual field loss and cupping were noted in the left eye, despite good IOP control. He was advised to discontinue all future inversion table therapy. Again, he underwent uncomplicated retinal detachment repair by vitrectomy, gas-fluid exchange, and endolaser therapy. On further questioning, the patient indicated that he had been utilizing inversion table therapy several times a month, for several minutes at a time, over the previous seven years for back pain. Examination of the right eye demonstrated an attached retina, pigmented laser scars for 360 degrees and a cup-to-disc ratio of 0.6. There were two retinal tears anterior to the equator at four o’clock and six o’clock and an additional retinal tear at seven o’clock immediately posterior to the equator adjacent to the inferonasal retinal vessels. Funduscopic examination of the left eye demonstrated the progression of his glaucomatous optic neuropathy (cup-to-disc ratio of 0.6) with a macular splitting retinal detachment from three to eight o’clock associated with multiple retinal tears. Other than the presence of well-positioned intraocular lenses bilaterally, the anterior segment examination was unchanged from the previous year. He was taking brimonidine and travoprost in both eyes. Over the proceeding months, he had been placed on multiple IOP lower medications due to the progression of his glaucoma, left greater than right, by his primary eye care provider. His visual acuity was 20/30 and the intraocular pressure (IOP) was normal in both eyes. The patient underwent an uncomplicated retinal detachment repair by vitrectomy, gas-fluid exchange and endolaser therapy, followed by cataract extraction with intraocular lens placement in both eyes six months later.Įleven months after the onset of a retinal detachment in the right eye, the patient presented with a “dark curtain” and flashes involving the superior visual field of his left eye. Fundus examination of the left eye demonstrated inferior chorioretinal and pigmentary changes, a cup-to-disc ratio of 0.4, but otherwise normal findings. Funduscopic examination of the right eye revealed a cup-to-disc ratio of 0.6 and a macula-off retinal detachment from five to ten o’clock, secondary to a retinal break adjacent to an area of pigmented lattice degeneration at seven o’clock. At this time, the patient was not on IOP-lowering medications. Ocular examination revealed multiple iris transillumination defects, mild age-related nuclear sclerotic cataracts and open angles with pigmentation in the trabecular meshwork by gonioscopy and normal intraocular pressure (IOP) bilaterally. His visual acuity was 20/70 in the right eye and 20/20 in the left eye with correction. He was mildly myopic with a refraction of -0.75 -2.00 055 in the right eye and -0.75 -2.25 090 in the left eye. His ocular history was significant for a diagnosis of pigment dispersion glaucoma for which he was being treated with topical intraocular pressure (IOP) lowering agents and multiple bilateral blepharoplasty procedures. A 67-year-old male with a medical history of hypertension and heart failure presented to our clinic with an ocular complaint of floaters and superotemporal visual field loss in his right eye for three days.

Pigmented lattice degeneration