Ocular decompression retinopathy solely following medical treatment in steroid induced glaucoma Case report
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Abstract
An 18-year-old male developed bilateral, steroid induced glaucoma and steroid induced cataract following topical steroid usage. Best corrected visual acuity was 6/60 and perception of light in right eye and left eye respectively. Both eyes had clear cornea, 7–8 mm sluggishly reacting pupil with an immature cortical cataract and advanced glaucomatous optic neuropathy in right eye and a near mature cortical cataract in left eye. Intraocular pressure (IOP) was ≥50 mmHg and angles were open on gonioscopy in both eyes. Tablet acetazolamide 250 mg q.i.d. for 1 week along with brimonidine 0.15% and timolol 0.5% fixed combination eye drops b.d, brinzolamide 1% eye drops t.d.s and netarsudil 0.02% eye drops o.d. were prescribed for both eyes. At 2 weeks follow up, IOP reduced to 14 mmHg and 18 mmHg in right eye and left eye respectively. However, surprisingly, the right eye showed multiple intraretinal blot haemorrhages, in greater numbers temporally and extending towards the equator in all quadrants. Post phacoemulsification, the left eye fundoscopy revealed very advanced glaucomatous optic neuropathy with two intraretinal blot haemorrhages. The best corrected visual acuity improved only marginally upto 6/36 (post phacotrabeculectomy) and hand movement (post phacoemulsification) in right eye and left eye respectively. At 8 weeks post right eye phacotrabeculectomy, all the haemorrhages resolved completely in both eyes without any intervention. This case developed ocular decompression retinopathy (ODR) solely following oral and topical IOP lowering therapy which is rare. It shows that an aggressive IOP reduction, meant to reduce the risk of postoperative ODR, can occasionally itself become the cause of ODR. This case also demonstrates that, such a reduction can still be exercised in crucial situations, in order to preserve vision and prevent blindness, since ODR is usually a self-resolving condition having a benign course.
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