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Ocular decompression retinopathy after trabeculectomy for secondary glaucoma after complicated phacoemulsification

Poster Details

First Author: N.Surchev BULGARIA

Co Author(s):    Y. Kirilova                    

Abstract Details

Purpose:

To present a patient with secondary glaucoma after phacoemulsification with posterior capsule rupture (PCR) who developed ocular decompression retinopathy post trabeculectomy.

Setting:

University Eye Hospital �â�€�œAkad. Pashev�â�€�

Methods:

A 79 years old female underwent a phacoemulsification in the right eye, which was complicated by PCR. An anterior vitrectomy with lens implantation in the sulcus was done. Best corrected visual acuity (BCVA) was 1.0 but the patient developed secondary glaucoma with corneal edema 10 days after surgery. Maximum conservative therapy with 4 anti-glaucomatous drugs failed to control the elevated intraocular pressure (IOP). Because progressive visual fields were detected a decision was made to perform a trabeculectomy 3 weeks after IOP increase.

Results:

Preoperatively the patient was treated with active osmotic therapy (acetazolamide and mannitol). Despite that, trabeculectomy had to be performed with an initial IOP of 43 mmHg. On the next day IOP was 9 mmHg, the cornea was clear but fundus examination revealed peripapillary hemorrhages, optic disc edema and multiple retinal hemorrhages. The diagnosis of ocular decompression retinopathy was made and a treatment regimen of anti-inflammatory eye drops was started. During follow up the changes gradually disappeared without residual retinal and vascular alterations. On 4th month follow up IOP was 14 mmHg with BCVA of 0.8.

Conclusions:

Ocular decompression retinopathy is a rare complication which is suggested to be caused by a rapid reduction of IOP. Initially described after trabeculectomy it has been noted after other surgical procedures (phacoemulsification, canaloplasty) and even after conservative IOP lowering therapy. The prognosis after ocular decompression retinopathy is usually good. The avoidance of sudden significant decrease of IOP is the best way to prevent this complication. In our case even though maximal topical and systemic IOP-lowering therapy was administered, we were unable to reach an acceptable IOP level. However, glaucomatous changes required an intervention without further delay.

Financial Disclosure:

NONE

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