ENTREGA DE ACTIVIDAD POR PARTE DEL ESTUDIANTE

1. Identificación del curso:

Programa académico: Ingeniería

Biomédica Nombre del curso: Biofísica
Número de clase: 6BN
Temática: Articulo de caso clínico
Objetivo: Realizar un caso clínico sobre alguna patología relacionada con el sistema visual o auditivo
Estrategia didáctica: Articulo científico

2. Identificación Estudiante

Nombre Completo: Paula Andrea Barrero

Cepeda Código: 77296
Fecha: 17/05/2024

Nombre Completo: Diego Fernando Parra

Vargas Código: 80999
Fecha: 17/05/2024

Nombre Completo: Albert Pulido

Pulido Código: 113035
Fecha: 17/05/2024

Nombre Completo: Katherinn Tatiana Rozo

Escamilla Código: 109951
Fecha: 17/05/2024
1. Actividades desarrolladas

Escribir un informe sobre un caso clínico en formato Artículo tipo IEEE en inglés. El informe debe describir un caso
clínico de alguna patología relacionada con el sistema visual o auditivo, dicho caso debe ser procedente de un artículo
científico publicado entre los años 2021 a 2024. El estudiante debe realizar un análisis biofísico relacionando los temas
vistos en clase. El informe debe contener mínimo 4 páginas y máximo 6 páginas. Adicionalmente debe tener mínimo 4
referencias de artículos científicos. El informe de artículo debe ser sustentado por todos los integrantes del grupo.
 Case Study “Ghost Cell Glaucoma.”
ESTUDIO DE CASO “GLAUCOMA DE CELULAS FANTASMAS”

Paula Barrero, Diego Parra, Albert Pulido, Katherinn Rozo Universidad ECCI, Bogotá Colombia

[email protected]
[email protected]
[email protected]
[email protected]

Summary:

Glaucoma is an eye disease that affects the optic nerve, resulting in progressive vision loss. It affects more than
11 million people worldwide. This condition is characterized by the degeneration of retinal ganglion cells and
the narrowing of the visual field, its main cause being increased intraocular pressure. The optic disc, where the
axons of retinal ganglion cells converge, is crucial in the process of transmitting visual information to the brain.
Here, the axons fuse, rotate 90 degrees, and pass through the sclera and cribriform plate. While glaucoma can
affect people of any age, it is more common in older adults.
Among the types of glaucoma, there is ghost cell glaucoma, characterized by symptoms such as increased
intraocular pressure, eye pain, corneal edema, and eye redness, among others. This type of glaucoma can have
serious consequences if not treated properly, as it can lead to significant vision loss and even irreversible
blindness. In our clinical case, we will analyze the case of a 49-year-old man who experiences decreased vision
and pain in his right eye. This discomfort is linked to an incident that occurred two months ago, when he was
hit by a ball. In addition, it is relevant to mention your medical history of type II diabetes mellitus.
In this article, we will explore the medical procedures carried out once a person is diagnosed with ghost cell
glaucoma and examine the relationship between the principles of biophysics and this particular clinical case.

Keywords: Decreased vision, Intraocular Pressure, Ghost Cells

 1. Introducción:
This article will focus on the application of understand in detail due to its impact on ocular health.
biophysics in the treatment of eye diseases, such as It is believed that pseudoexfoliation material, primarily
glaucoma, with an emphasis on ghost cell composed of degenerated erythrocytes, can have a
glaucoma, which is a type of secondary glaucoma significant influence on increasing intraocular pressure
common in older adults. The nature of glaucoma, and thus progressive damage to the optic nerve and loss
its characteristic symptoms and distinctive signs of vision. [2]
will be examined, as well as the progressive effects In its progression, pseudoexfoliation material can
that this condition can have on the visual system adhere to internal eye structures such as vitreous
and the patient's general well-being will be strands and eventually reach the posterior chamber,
explored. where it can further increase intraocular pressure. This
accumulation of material and the consequent
2. General objetive obstruction of trabecular outflow can lead to further
optic nerve and vision deterioration. [2]
✓ Analyze the application of biophysics in the Accurate diagnosis of this disease requires thorough
management of ghost cell glaucoma, ophthalmological evaluation, where signs such as
understanding its nature, signs and symptoms, as vitreous hemorrhage, increased intraocular pressure,
well as the adverse effects it produces on the body. and changes in visual acuity can be identified.
Additionally, it is essential to differentiate it from other
3. Specific objetive conditions that may present similar symptoms, such as
the various types of glaucoma mentioned earlier. [2]
✓ Define and characterize ghost cell glaucoma Treatment for this disease can vary depending on
including its causes and pathophysiological severity and patient status. In mild cases, conservative
mechanisms. measures such as intraocular pressure control and
✓ Evaluate the effectiveness and benefits of regular monitoring may suffice. However, in advanced
biophysical-based interventions in managing stages where vision and optic nerve function are
pseudoexfoliation glaucoma, considering their significantly compromised, surgical intervention such
impact on quality of life and disease progression. as vitrectomy may be necessary to relieve obstruction
✓ Present the results of the calculations performed and reduce intraocular pressure. [2]
regarding the acquired knowledge. 4. Causes
Pseudoexfoliation glaucoma is a type of secondary
4. Theoretical Framework open-angle glaucoma that develops following
Pseudoexfoliation glaucoma, although often prolonged vitreous hemorrhage. It is characterized by
overlooked or misdiagnosed, is important to the presence of residual blood cells in the anterior
 chamber of the eye, intraocular pressure. [3]
which can obstruct 6. Symptoms:
the flow of aqueous humor and increase intraocular Pseudoexfoliation glaucoma (PEG) is a rare condition
pressure. that develops as a result of degenerated erythrocytes,
The proposed mechanism for the appearance of known as pseudoexfoliation material, which form after
pseudoexfoliation material in the anterior chamber prolonged vitreous hemorrhage. Symptoms of
involves several steps: [2] pseudoexfoliation glaucoma may include: [5]
- Prolonged vitreous hemorrhage: Prolonged vitreous - Ocular pain: Patients may experience discomfort or
hemorrhage can occur due to various conditions pain in the affected eye. [4]
such as ocular trauma, diabetic retinopathy, or - Prolonged elevation of intraocular pressure (IOP):
retinal detachment, among others. [3] Sustained increase in pressure within the eye is
- Liquefaction and degeneration of the vitreous: observed. [4]
Over time, the vitreous can undergo structural - Decreased visual acuity: There may be a reduction in
changes resulting in its liquefaction and the sharpness of vision. [4]
degeneration. This process can be accelerated by - Absence of keratic precipitates: Deposits on the
the presence of blood in the vitreous. [3] cornea are not observed. [4]
- Defect in the anterior hyaloid face: It is proposed - Open iridocorneal angle: Evaluated by gonioscopy,
that during the process of liquefaction and the angle between the iris and the cornea remains open.
degeneration of the vitreous, a spontaneous defect [4]
occurs in the anterior hyaloid face. This membrane - Presence of fine khaki-colored cells in the anterior
separates the vitreous from the anterior chamber of chamber: Spherical khaki-colored pseudoexfoliation
the eye. [3] cells may be observed in the anterior chamber of the
- Passage of pseudoexfoliation material to the eye. [4]
anterior chamber: The defect in the anterior - They can also be deposited in pseudo-hypopyon form
hyaloid face allows the passage of residual blood or on a persistent hyphema secondary to previous
cells, known as pseudoexfoliation material, from ocular trauma: Pseudoexfoliation cells can be
the vitreous space into the anterior chamber of the deposited forming pseudo-hypopyon (accumulation of
eye. [3] cells in the lower part of the anterior chamber) or on a
- Obstruction of trabecular outflow: Once in the persistent hyphema (bleeding in the anterior chamber).
anterior chamber, pseudoexfoliation material can [4]
obstruct the trabecular meshwork, which is - Candy cane sign: A double-layer level can be
responsible for draining aqueous humor out of the observed in the hyphema, with an upper layer of red
eye. This obstruction can lead to an increase in color due to fresh red blood cells and a lower khaki-
 colored layer An ocular tomography is performed to obtain a detailed
corresponding to image of the retina, macula, and optic nerve. This
pseudoexfoliation cells, known as the candy cane reveals punctate clarity of moderate density in the
sign. [4] anterior chamber. Subsequently, an ultrasound is
7. Clinical Case: performed showing diffuse increased brightness in all
This concerns a 49-year-old man presenting with four quadrants, indicative of vitreous hemorrhage. [1]
decreased visual acuity and persistent pain in his
right eye. He reports having Type II Diabetes
Mellitus and recalls experiencing a blow to the eye
with a ball approximately 2 months ago. Upon
examination, it is observed that his corrected visual
acuity is so low that he can barely distinguish
fingers at one meter, thus requiring corrective
lenses. Additionally, an elevated intraocular
pressure of 40mmHg is recorded.[1]
Figure 2: B-Mode Ultrasound of the Right Eye (OD). Diffuse
Upon examining the front part of the eye,
increase in echogenicity, consistent with vitreous hemorrhage.
responsible for focusing light rays, signs of Taken from [1].
inflammation such as corneal edema, scleral The physician performs a paracentesis to obtain a
redness, and presence of blood in the anterior sample of the aqueous humor, and upon analysis with
chamber are found, manifested as "Hemorrhagic hematoxylin and eosin, the presence of spherical
Tyndall," referring to small floating particles in the erythrocytes with hemoglobin residues is observed. [1]
eye's humor. [1]

Figure 3: Histology of the aqueous humor of the Right Eye (OD).

Presence of Heinz bodies. Taken from [1].
Figure 1: Anterior Segment Biomicroscopy of the Right Eye
(OD). Presence of 3+ Hemorrhagic Tyndall, formed anterior
The patient initiates topical treatment, but despite
chamber. Taken from [1]. consistent use, satisfactory results are not achieved, and
 the intraocular device. The primary goal of this surgery was to control
pressure remains intraocular pressure and improve the patient's visual
high. Therefore, surgery is opted for, in which a prognosis. [1]
pars plana vitrectomy is performed, the anterior Following the surgical procedure, the patient
chamber is irrigated, and a Baerveldt non-valved experienced a notable improvement in symptoms such
drainage device is implanted in the right eye. as pain, redness, discomfort, and elevated intraocular
Fortunately, expected results are achieved in the pressure. [1]
postoperative period, and adequate recovery is The patient will continue to be closely monitored to
attained. [1] prevent further vision loss, implementing necessary
preventive measures to optimize their recovery and
8. Treatment: promote better long-term quality of life. [1]
Based on the previous findings, a diagnosis of
pseudoexfoliation glaucoma (PEG) is reached, and 10. Biophysics concepts
medical treatment begins with ophthalmic drops of In the context of glaucoma, the properties of light as it
0.5% Timolol every 12 hours, 2% Dorzolamide passes through the eye and its different structures are
every 12 hours, 2% Brimonidine every 8 hours, in often studied. Suppose light hits the eye's lens, which
addition to 250mg oral Acetazolamide every 8 acts similarly to a piece of Crown glass. If light enters
hours. However, in the subsequent evaluation, it is the lens at an angle of 50° with respect to the normal,
observed that intraocular pressure (IOP) remains what would be the angle of refraction in this case?
high. Given the disease progression and lack of
response to medical treatment, a surgical option is 𝑛1 𝑆𝑒𝑛𝜃1 (1.33)(𝑠𝑒𝑛50°)
𝑆𝑒𝑛 𝜃2 = = = 0.67
decided upon. Surgery is performed, including pars 𝑛2 1.52

plana vitrectomy, irrigation of the anterior

chamber, and insertion of a non-valved Baerveldt 𝜃2 = 𝑠𝑒𝑛−1 (0.67) = 42°

drainage device in the right eye. [1]

The angle of refraction would be 42°.

9. Results:
After initial topical medical treatment failed to In designing ophthalmic lenses to treat glaucoma, it is

achieve the desired reduction in intraocular crucial to understand the curvature of the lens surfaces

pressure, the decision was made to opt for surgical and how they affect the refraction of light in the eye.

intervention. This intervention included Let's consider a lens designed to correct vision in

vitrectomy, irrigation of the anterior chamber, and patients with glaucoma. The concave surface of this

placement of a non-valved Baerveldt drainage lens has a negative radius of curvature, while the
 convex surface has would be the size of A'B', the image formed by this
a positive radius of ocular feature in the eye of the glaucoma patient, if the
curvature. Using the lens designer's formula, where object is at a distance of 300 cm of the eye
the refractive index is 1.6, and the radii of curvature 𝐴𝐵 ∗ 𝐵`𝑁
𝐴′ 𝐵 ′ =
are 0.1 m for the concave surface (R1) and 0.9 m 𝐵𝑁
13 𝑐𝑚 ∗ 2.0 𝑐𝑚
for the convex surface (R2), how can the optical 𝐴′ 𝐵 ′ = = 0.086 𝑐𝑚
300 𝑐𝑚
properties be calculated? of this ophthalmic lens in
In the diagnosis of glaucoma, early detection of
relation to the treatment of glaucoma?
changes in the optic nerve is essential. Let's consider a
situation where a converging lens is used to magnify
1 1 1
= (𝑛 − 1) ( + ) the image of the optic nerve in a patient with glaucoma.
𝑓 𝑅1 𝑅2
The focal length of the lens is 0.50 m, and we want to
1 1 1
= (1.6 − 1) ( + ) form a virtual image, upright and three times larger than
𝑓 −0.1 0.9
𝑓 = −5.33 𝑚 (𝑑𝑖𝑣𝑒𝑟𝑔𝑒𝑛𝑡 𝑙𝑒𝑛𝑠) the optic nerve, which has a height of 1 cm. How far
should the lens be placed from the optic nerve to

During the process of accommodating the eye to achieve this magnification and form a virtual image?

focus on close objects, as part of the clinical

evaluation of glaucoma, the distance of the object 𝑠′ 𝑠′
𝑚= ; 3 = ; 𝑠` = 3𝑠
𝑠 𝑠
to be focused is adjusted to p = xp. Since q is again
1 1 1 1 1 1 2 2
qo, how does the power of the eye change in this ′
− = ′ ; − = ′ ; 𝑠 = − 𝑓 ′ = − 0,50 𝑚
𝑠 𝑠 𝑓 3𝑠 𝑠 𝑓 3 3
state of accommodation? 1
= − 𝑚 ≈ −0,33𝑚
For a person with normal vision 𝒙𝒑 = 3
𝟎. 𝟐𝟓 𝒎 and for 𝒒𝟎 is the distance at which they 𝑠 ′ = 3𝑠 = 3(−0,33)𝑚 = −0,99𝑚

are located. We will use 0.1 m 11. Gratitude

1 1 1 1 1 1 1 Upon analyzing the clinical case and applying the

𝑃𝑝 = = + = + = +
𝑓 𝑝 𝑞 𝑥𝑝 𝑞𝑜 0.25 0.1 knowledge acquired in the third quarter, various
questions arose that could be resolved during the
𝑃𝑝 = 14 𝑑𝑖𝑜𝑝𝑡𝑒𝑟𝑠 research. We want to express our gratitude to our
teacher, whose methodology and mastery of the subject
Let's imagine that object AB represents a relevant provided us with the essential tools to carry out the task
ocular characteristic in a glaucoma patient effectively. Additionally, we want to acknowledge the
measuring 13 cm. Given that the distance NB' in a contribution of each team member, who contributed
normal eye measure approximately 20 mm, what their knowledge and time to fulfill the proposed
 activity. optica/. Consulted on 05/07/2024.

12. Conclusions [5] A. Lazo, “Phantom Cell Glaucoma Secondary to

It is important to highlight that, although Terson Syndrome in a Phakic Eye.” Central American
pseudoexfoliation glaucoma is not common, timely Journals Online, vol 4, no 3, 2021.
diagnosis is crucial. It is essential not to confuse it
with other types of glaucoma, as late treatment can
cause irreversible damage, such as vision loss.
Therefore, it is necessary to provide appropriate
treatment using the appropriate medical equipment
to control this disease. Regular check-ups are
essential, as glaucoma is a chronic condition that
requires ongoing management, which may include
medications. Additionally, intraocular pressure and
optic nerve health should be constantly monitored,
as these are often the most affected areas.

13. Bibliography

[1] D. Mamani, N. Pantoja. «Ghost cell glaucoma:

Clinical Case» Journal of the Faculty of Human
Medicine, vol. 23, no.1, pp 121-125, 2023.

[2] I. Temblador, A. Gonzalez, JD. Lopez, M.

Martinez, J. Benitez. «Ghost cell glaucoma»
Current Medical Magazine, vol 104, no. 806, pp
46-47, 2019.

[3] National Eye Institute. Available:

https://n9.cl/vwj74. Accessed 05/05/2024.

[4] Visual Optics and Optometry. Available:

https://visualizaoptica.es/glaucoma-visualiza-