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Research Letter |

Proteomic Analysis of Macular Fluid Associated With Advanced Glaucomatous Excavation

Shriji Patel, MD1; Jeanie Ling, MD1; Stephen J. Kim, MD1; Kevin L. Schey, PhD1,2; Kristie Rose, PhD1,2; Rachel W. Kuchtey, MD, PhD1,3
[+] Author Affiliations
1Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
2Department of Biochemistry, Vanderbilt University, Nashville, Tennessee
3Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
JAMA Ophthalmol. 2016;134(1):108-110. doi:10.1001/jamaophthalmol.2015.4105.
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This case report describes the proteomic analysis of macular schisis fluid in a case of advanced glaucomatous cupping.

The association of maculopathy with advanced glaucomatous cupping is known, but controversy remains over the origin of fluid.13 Reports using enhanced depth imaging have demonstrated a track communicating from cavities posterior to the lamina cribrosa to the peripapillary retina, and these cavities presumably consist of cerebrospinal fluid (CSF).2,3

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Figure 1.
Color Fundus Photographs and Optical Coherence Tomography (OCT) of the Right and Left Eyes

A-D, Color fundus photographs of the right (A) and left (B) eyes, and OCT images of the right (C) and left (D) eyes. C, The right eye demonstrates glaucomatous excavation with a large macular schisis cavity on OCT. D, The left eye also shows glaucomatous changes but normal macular architecture.

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Figure 2.
Fluorescein Angiograms (FAs) and Enhanced Depth Imaging Optical Coherence Tomography (OCT) of the Right Eye

A and B, Early (A) and late (B) FAs show normal transit time as well as absence of vascular obstruction or vessel leakage. C, Enhanced depth imaging OCT through the optic nerve demonstrates a fluid cavity without visible defect in the lamina cribrosa or communication between the optic nerve and schisis pocket.

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