Uveal effusion induced by topical travoprost in a patient with Sturge-Weber-Krabbe syndrome

Serous Retinal Detachment in a Patient With a Port-Wine Birthmark Associated With Prostaglandin Analog Therapy

An 11-year-old girl with a port-wine birthmark (PWB), diffuse choroid hemangioma (DCH), and glaucoma experienced decreased vision upon starting treatment with bimatoprost. The patient was switched to latanoprostene bunod. Her vision remained reduced. Shortly after, she was diagnosed with serous retinal detachment (SRD). Both SRD and vision improved following prostaglandin analog (PGA) cessation. Patients with PWB are likely to have DCH and glaucoma. DCH itself poses a risk factor for SRD. Certain glaucoma management modalities may further increase this risk. This report highlights the importance of regular surveillance for SRD in patients with DCH who are receiving PGA. [Ophthalmic Surg Lasers Imaging Retina 2023;54:723-729.].

[Secondary open-angle glaucoma: uveitic secondary glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, tumor-related glaucoma and glaucoma due to elevated episcleral venous pressure]

Secondary open-angle glaucomas are a heterogeneous group of diseases in which a variety of pathophysiological mechanisms result in an elevation of intraocular pressure (IOP). In contrast to primary open-angle glaucoma in many cases besides IOP reduction a causal treatment is possible. This article is the second part of a review of the more frequently encountered forms of secondary open-angle glaucoma. Uveitic glaucoma, steroid-induced glaucoma, posttraumatic and postoperative glaucoma, glaucoma due to intraocular tumors and caused by elevated episcleral venous pressure are covered. The underlying pathophysiological mechanisms, characteristic clinical findings and treatment options are discussed.

Serous macular detachments associated with topical travoprost

Here is presented a unique case of bilateral serous macular detachments as a side effect of topical travoprost (0.004%) therapy. Only three other cases in the literature have definitively associated this side effect with other topical prostaglandins. The aetiological and pathophysiological pathways remain to be clearly elucidated but are potentially related to increased choroidal vascular permeability. In this case, the subretinal fluid resolved rapidly and completely after cessation of travoprost drops, showing it to be a reversible pathology similar to prostaglandin-associated cystoid macular oedema. This uncommon association is therefore important to consider in the differential diagnosis of serous macular detachment. Increasing ophthalmic awareness could help to prevent unnecessary investigations in undifferentiated patients without other guiding historical or examination features. This may save time and expense for the patient and health systems.

Progressive retinal vessel malformation in a premature infant with Sturge-Weber syndrome: a case report and a literature review of ocular manifestations in Sturge-Weber syndrome

BACKGROUND

Sturge-Weber syndrome is a disorder marked by a distinctive facial capillary malformation, neurological abnormalities, and ocular abnormalities such as glaucoma and choroidal hemangioma.

CASE PRESENTATION

We report a case of progressively formed retinal vessel malformation in a premature male infant with Sturge-Weber syndrome and retinopathy of prematurity, after treatment with intravitreal anti-vascular endothelial growth factor (VEGF). The baby was born at 30 weeks gestation with a nevus flammeus involving his left eyelids and maxillary area. On postmenstrual age week 39, he received intravitreal anti-VEGF. Diffuse choroidal hemangioma became evident at 40 weeks, with the classic "tomato catsup fundus" appearance. These clinical findings characterized Sturge-weber syndrome. He presented with posterior retinal vessel tortuosity and vein-to-vein anastomoses at 44 weeks.

CONCLUSION

This is a rare case of documented progression of retinal vessel malformations in a patient with Sturge-Weber syndrome and retinopathy of prematurity.

Bimatoprost-induced late-onset choroidal detachment after trabeculectomy: A case report and review of the literature

BACKGROUND

Choroidal detachment (CD) is often observed at an early period particularly after trabeculectomy and glaucoma drainage implant surgery. However, topical antiglaucoma eye drop-induced CD is a rare complication. Here, we report a case of topical bimatoprost-induced late-onset CD after trabeculectomy and review the literature.

CASE REPORT

A 74-year-old man who suffered from primary open-angle glaucoma underwent his initial trabeculectomy with mitomycin-C in the right eye. Before the surgery, his intraocular pressure (IOP) was 20 to 22 mm Hg with bimatoprost 0.03%, dorzolamide 1%, and brimonidine 0.1% and his best corrected visual acuity (BCVA) was 0.9. The mean deviation in Humphrey Visual Field Analyzer (24-2 program) was -27.83 db. After successful trabeculectomy, IOPs were 11 to 16 mm Hg without any medication. Eight months after the surgery, we restarted bimatoprost to further reduce the IOP in the right eye, which was 15 mm Hg. At a hospital visit 2 months later, he complained of blurred vision that had persisted for the past 1 month; his IOP had decreased to 9 mm Hg. His BCVA was 0.04 and 3 quadrant CD was found. We discontinued bimatoprost and started him on betamethasone 0.1% 4 times per day. However, CD marginally changed after 1 week, with IOP at 7 mm Hg; thus, we performed scleral drainage for CD. After 3 weeks of drainage, CD completely disappeared. IOP increased to 16 mm Hg and BCVA was 0.7. However, 3 months after the drainage, IOP increased to 29 mm Hg, and needling revision was thus performed. After the surgery, IOP remained at 14 to 16 mm Hg without any glaucoma medication and CD recurrence. A review of the literature showed that various antiglaucoma medications induce CD, regardless of the preceding glaucoma surgery and that CD is usually resolved by withdrawing the medication and administering topical steroids. However, most previous studies have shown the recurrence of CD by rechallenging the same drug.

CONCLUSION

In our case, topical bimatoprost induced late-onset CD after trabeculectomy. Early scleral drainage may be a good option to quickly resolve drug-induced CD and prevent its recurrence. Therefore, it must be kept in mind that various antiglaucoma medications induce CD.

Pediatric Glaucoma: Pharmacotherapeutic Options

Childhood glaucoma is a major therapeutic challenge for pediatric ophthalmologists and glaucoma specialists worldwide. Management depends on the etiology and age at presentation. A variety of drugs are available for the control of intraocular pressure in children; however, none of these drugs have been licensed by the regulatory agencies for use in children. Furthermore, evidence gained from randomized controlled trials in the pediatric population is sparse, and little is known regarding the use of newer anti-glaucoma preparations. This evidence-based review aims to discuss the available pharmacotherapeutic options for glaucoma in children. Topical adrenoceptor blockers, topical and systemic carbonic anhydrase inhibitors, prostaglandin (PG) analogs, adrenoceptor agonists, parasympathomimetics, and combined preparations are available for use in children, but usually as an off-label indication. Therefore, it is important to recognize that serious side effects have been reported, even with topical drops, and measures to reduce systemic absorption should be taken. Most drugs have been shown to have comparable ocular hypotensive effects, with the lowest occurrence of systemic side effects with PG analogs. Whereas a newly introduced prostaglandin analog, tafluprost, and some other preservative-free preparations have shown promising results in adult glaucoma patients, no pediatric reports are available as yet. Future studies may describe their role in treating pediatric glaucoma. This review also shares some suggested treatment pathways for primary congenital glaucoma (PCG), juvenile open angle glaucoma (JOAG), developmental glaucoma, aphakic/pseudophakic glaucoma, and uveitic glaucoma.

Sturge-Weber syndrome: decrease in intraocular pressure after transpupillary thermotherapy for diffuse choroidal haemangioma

PURPOSE

To report intraocular pressure (IOP) reduction after selective and partial destruction of diffuse choroidal haemangioma (DCH) by transpupillary thermotherapy (TTT) using an 810 nm infrared diode laser in two patients with Sturge-Weber syndrome (SWS) having late-onset juvenile glaucoma (LOJG).

METHODS

An interventional small case series. Laser spots (diameter, 1 mm) were applied to the tumour surface located outside the posterior pole. Energy level (600-1700 mW) and exposure time (1-4 seconds) were increased stepwise until the tumour exhibited a greyish discoloration. The treatment was split into 2-4 sessions.

RESULTS

Before TTT, both patients had uncontrolled LOJG with an IOP of 23 mmHg (Case 1) and 45 mmHg (Case 2) in spite of topical medications. In both cases, TTT led to normalization of IOP to 15 mmHg and 24 mmHg, respectively, and stopped the progression of LOJG during a follow-up period of 6 years (Case 1) and 1 year (Case 2). Visual loss or other complications were not observed.

CONCLUSIONS

Our study highlights the close link that exists between LOJG and DCH in SWS. A single treatment modality such as TTT may both reduce IOP in LOJG and help to prevent exudative retinal detachment in DCH. We believe that TTT is a good therapeutic option for SWS patients who have both DCH and LOJG.