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

Autor: Figueiredo ARM; Ophthalmology Department - Centro Hospital do Porto, EPE - Hospital de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal. anamarcosfigueiredo@gmail.com., Sampaio IC; Ophthalmology Department - Centro Hospital do Porto, EPE - Hospital de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal., Menéres MJFDS; Ophthalmology Department - Centro Hospital do Porto, EPE - Hospital de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal., Spaeth GL; Wills Eye Hospital, Jefferson Medical College, 840 Walnut Street, Philadelphia, PA, 19107, USA.
Jazyk: angličtina
Zdroj: Journal of medical case reports [J Med Case Rep] 2016 Feb 04; Vol. 10, pp. 32. Date of Electronic Publication: 2016 Feb 04.
DOI: 10.1186/s13256-016-0814-x
Abstrakt: 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.
Databáze: MEDLINE
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