Consecutive bilateral decompression retinopathy after mitomycin C trabeculectomy: a case report

Journal of Medical Case Reports

George L. Spaeth¹  Maria João Fernandes dos Santos Menéres²  Isabel Coutinho Sampaio²  Ana Raquel Marcos Figueiredo² 

[1] Wills Eye Hospital, Jefferson Medical College, 840 Walnut Street, Philadelphia 19107, PA, USA;Ophthalmology Department - Centro Hospital do Porto, EPE – Hospital de Santo António, Largo Professor Abel Salazar, Porto, 4099-001, Portugal

关键词: Trabeculectomy;    Retinal hemorrhages;    Open angle glaucoma;    Macular edema;    Decompression retinopathy;   

Others  :  1235807
DOI  :  10.1186/s13256-016-0814-x

 received in 2015-05-07, accepted in 2016-01-14,  发布年份 2016

【 摘 要 】

Background

After a successful trabeculectomy, a sudden intraocular pressure decrease may alter the intracranial to intraocular pressure ratio and cause decompression retinopathy. Frequent Valsalva maneuvers may also play a role in its pathogenesis. This condition may manifest as multiple retinal hemorrhages, edema of the optic disc, macular edema, or a sudden decrease in visual acuity postoperatively. Outcomes for patients are usually good, with spontaneous resolution occurring within a matter of weeks. It has been rarely reported in the literature as a bilateral condition.

Case presentation

We present a case of consecutive bilateral decompression retinopathy in a 54-year-old severely obese Caucasian woman (body mass index 37 kg/m ² ) with open angle glaucoma and a poor history of medical therapeutic compliance, who chose surgical treatment based on her inability to consistently use ocular drops. Our patient underwent a trabeculectomy with mitomycin C in both eyes, with surgeries taking place 3 months apart. After the first surgery, 2 weeks postoperatively, she complained of decreased visual acuity. Examination of her right eye fundus revealed multiple retinal hemorrhages and disc edema. There was a similar pattern in her left eye, this time including maculopathy. Her visual acuity and fundoscopic changes resolved spontaneously over a period of a month in both cases. Currently, our patient has well-controlled bilateral intraocular pressure, ranging between 14 and 16 mmHg, without hypotensive medication.

Conclusions

Decompression retinopathy is a potential complication after glaucoma surgery, but has rarely been described as a bilateral consecutive condition. A comprehensive approach could help to anticipate its occurrence and manage it.

【 授权许可】

   
2016 Figueiredo et al.

【 图 表 】

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