Central retinal vein occlusion after trabeculectomy with mitomycin C

OCULAR DECOMPRESSION RETINOPATHY WITH BRANCH RETINAL VEIN OCCLUSION MTHF-R GENETIC MUTATION

PURPOSE

An atypical case of a sectorial decompression retinopathy with branch retinal vein occlusion following trabeculectomy was reported and was diagnosed with optical coherence tomography angiography for which systemic genetic assessment revealed a MTHF-R mutation.

METHOD

Single case report.

RESULTS

A 68-year-old woman diagnosed with an uncontrolled bilateral creeping angle glaucoma went through an uncomplicated trabeculectomy in both eyes. Best-corrected visual acuity was 20/20. Intraocular pressure changed from 28 mmHg preoperatively to 5 mmHG postoperatively in the right eye. On the first postoperative day, best-corrected visual acuity was 20/32 with intraocular pressure measured to 5 mmHg. Fundus examination revealed sectorial temporal hemorrhages with tortuous temporal superior retinal vein arcade and choroidal folds. Fluorescein angiography evidenced a slight delay in venous filling along the supratemporal arcade. Three months later, optical coherence tomography angiography showed macular capillary loops in the superotemporal area of the retina. This sectorial decompression retinopathy was evocative of a branch retinal vein occlusion. At 6 months, best-corrected visual acuity returned to 20/20, with full regression of the hemorrhages. Systemic workup was normal, but genetic assessment revealed a MTHF-R mutation.

CONCLUSION

Retinal vein occlusion can be considered as a feature of ocular decompression retinopathy. The present case is the first case to associate branch retinal vein occlusion secondary to ocular decompression retinopathy to a MTHF-R mutation.

Decompression Retinopathy after Trabeculectomy

PURPOSE

To present a case of a unilateral diffuse retinal hemorrhage in a 15-year-old girl, who underwent bilateral trabeculectomy for steroid induced glaucoma.

METHODS

Despite the maximally tolerable medical treatment, IOP in the right eye remained above 50 mmHg for four months, and was simultaneously elevated in the left eye. So we performed bilateral trabeculectomy.

RESULTS

On the first postoperative day, diffuse retinal hemorrhages were observed in the right eye; however, no retinal hemorrhage was found in the left eye. The hemorrhages resolved completely without consequences two months later.

CONCLUSIONS

In the case of high IOP for a long period, sudden lowering of IOP may acutely increase the blood flow and consequently rupture multiple retinal capillaries because of altered autoregulatory function. Special care is therefore needed to prevent an abrupt fall in IOP before, during, and after surgery, especially when IOP has been highly elevated for an extended period.