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

Abstract

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.

Fig. 1

Right eye retinography, angiography, and optical coherence tomography 2 weeks after surgery. a Right eye fundus photograph showing multiple superficial, flame-shaped retinal hemorrhages located centrifugally from the optic disc associated with optic disc edema. b Fluorescein angiography exhibited macular microaneurysms associated with fluoroscein diffusion, peripapillary hemorrhages, and late optic disc leakage. c Optical coherence tomography image revealing folding of the macular retina and a small detachment of the neurosensory retina

Fig. 2

Right eye images 1 and 7 months after surgery. a, b Right eye fundus photograph and optical coherence tomography image 1 month after surgery. c, d Fundus photograph and optical coherence tomography image in the last follow-up visit (7 months after surgery). The peripapillary hemorrhages and optic disc edema spontaneously recovered

Fig. 3

Left eye retinography, optical coherence tomography (OCT), and angiography 10 days after surgery. a Fundus photograph showing multiple peripapillary retinal hemorrhages, optic disc swelling, and macular edema. b Optical coherence tomography revealed macular edema with neurosensory retinal detachment. c Angiography demonstrated choroidal striation, optic disc leakage, and signs of macular microangiopathy and epitheliopathy

Fig. 4

Left eye fundus photographs and optical coherence tomography image 2 and 4 months after surgery. a, c Gradual reduction of the localized hemorrhages and sectorial optic edema in the second postoperative month b, d Optical coherence tomography revealed progressive spontaneous macular edema recovery in the second postoperative month. e, f Images from the last visit (4 months after surgery)