Late postoperative choroidal detachment following an uneventful cataract surgery in a patient on topical latanoprost

Abstract

SUMMARYTopical latanoprost is a most effective and commonly used antiglaucoma medication. Use of prostaglandin analogues (PGA) in the early postoperative period is controversial due to its proinflammatory properties. We report a case of a 64-year-old man with primary open angle glaucoma, post-trabeculectomy 17 years prior, with good intraocular pressure (IOP) control on topical levobunolol 0.5% and latanoprost 0.005%. He underwent a clear corneal phacoemulsification surgery in his left eye and the PGA was stopped. He had an uneventful postoperative course and was prescribed eyeglasses at 4-week follow-up. Two weeks later, he presented to the emergency department with decreased vision in the left eye, flat anterior chamber, IOP of 00 mm Hg and 360°choroidal detachment. The continued use of topical latanoprost in the operated eye was implicated as the cause. This case illustrates the serious vision-threatening side effect of PGA when used in the early postoperative period. BACKGROUND

Minimally Invasive Surgery, Implantable Sensors, and Personalized Therapies

“…While the cases are too rare to warrant for a prospective study, there have been anecdotal cases suggesting that patients who were chronically treated with prostaglandins may be at a higher risk of developing choroidal pathologies. [28][29][30][31] This may be related to the effect of prostaglandins, reducing collagens within the uveoscleral pathway. [23] Furthermore, from a practical point of view, the suprachoroidal space may be less readily accessible and visualizable by a surgeon than the trabeculum.…”

“…[26] The pathophysiology of fibrosis is complex, but growth factors and cytokines expressed in inflammatory cells are clear culprits. [27] This is particularly problematic in glaucoma patients when inflammation is exacerbated through four mechanisms: (1) the predisposition of patients to conjunctival fibrosis through long-term use of topical prostaglandins or toxic preservative, both of which were associated with local inflammation, [28,29] (2) the surgical procedure itself, (3) subconjunctival flow, by itself, constitutes a persistent mechanical stress to local tissue, which was shown to translate into pro-inflammatory biochemical signals, [39][40][41] and (4) the mere presence of aqueous humor in the subconjunctival space, where it is not naturally present, was shown to promote tissue fibrosis. Some components, particularly TGF-b and VEGF-A, present at increased levels in the aqueous humor of glaucoma patients are believed to be responsible for subconjunctival fibrosis.…”