Document Detail


Recurrent annular peripheral choroidal detachment after trabeculectomy.
MedLine Citation:
PMID:  24348402     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
We report a challenging case of recurrent flat anterior chamber without hypotony after trabeculectomy in a 54-year-old Black male with a remote history of steroid-treated polymyositis, cataract surgery, and uncontrolled open angle glaucoma. The patient presented with a flat chamber on postoperative day 11, but had a normal fundus exam and intraocular pressure (IOP). Flat chamber persisted despite treatment with cycloplegics, steroids, and a Healon injection into the anterior chamber. A transverse B-scan of the peripheral fundus revealed a shallow annular peripheral choroidal detachment. The suprachoroidal fluid was drained. The patient presented 3 days later with a recurrent flat chamber and an annular peripheral choroidal effusion. The fluid was removed and reinforcement of the scleral flap was performed with the resolution of the flat anterior chamber. A large corneal epithelial defect developed after the second drainage. The oral prednisone was tapered quickly and the topical steroid was decreased. One week later, his vision decreased to count fingers with severe corneal stromal edema and Descemet's membrane folds that improved to 20/50 within 24 h of resumption of the oral steroid and frequent topical steroid. The patient's visual acuity improved to 20/20 following a slow withdrawal of the oral and topical steroid. Eight months after surgery, the IOP was 15 mm Hg without glaucoma medication. The detection of a shallow anterior choroidal detachment by transverse B-scan is critical to making the correct diagnosis. Severe cornea edema can occur if the steroid is withdrawn too quickly. Thus, steroids should be tapered cautiously in steroid-dependent patients.
Authors:
Shaohui Liu; Lisa L Sun; A Scott Kavanaugh; Marlyn P Langford; Chanping Liang
Publication Detail:
Type:  Journal Article     Date:  2013-10-24
Journal Detail:
Title:  Case reports in ophthalmology     Volume:  4     ISSN:  1663-2699     ISO Abbreviation:  Case Rep Ophthalmol     Publication Date:  2013  
Date Detail:
Created Date:  2013-12-18     Completed Date:  2013-12-18     Revised Date:  2014-01-24    
Medline Journal Info:
Nlm Unique ID:  101532006     Medline TA:  Case Rep Ophthalmol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  192-8     Citation Subset:  -    
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