Ocular decompression retinopathy after trabeculectomy with mitomycin-C for angle recession glaucoma

Abstract

A 45-year-old male presented with intractable glaucoma following 360-degree angle recession after blunt trauma. He underwent an uncomplicated trabeculectomy with mitomycin-C (MMC). Adequate precautions were taken to reduce the chances of sudden lowering of intraocular pressure (IOP). He did not have any intraoperative shallowing of the anterior chamber or postoperative hypotony, but still developed ocular decompression retinopathy. On detailed review of the previously reported cases we discovered that besides a large IOP drop after surgery, either the preoperative rise of IOP in all these cases was over a relatively short period or the course of their glaucomatous process was likely to have exposed them to intermittent spikes of high IOP. To our knowledge this factor has not been previously postulated in the pathophysiology of ocular decompression retinopathy. We illustrate this with a rare case of ocular decompression retinopathy after trabeculectomy with MMC for post-traumatic angle recession glaucoma.

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

“…A likely vascular mechanism of DR is the loss of autoregulation of the retinal vessels due to longstanding glaucoma, which overwhelms their capacity to respond to changes in IOP (that is, reduced retinal arterial resistance causing an increased flow and leakage through fragile capillaries), resulting in retinal hemorrhage [ 1 , 3 , 7 , 21 ]. Indeed, young individuals without hypertension or vasculopathy tolerate hemodynamic changes in choroidal vasculature very well.…”

“…Over the years, the word “ocular” has been dropped, and “ocular decompression retinopathy” is now described in the literature as “decompression retinopathy” (DR). Besides a large drop in IOP after surgery, many of the cases presented in the literature have demonstrated a significant increase in IOP over a relatively short period of time pre-surgery, or large variations in IOP with spikes followed by significant drops in pressure [ 3 ]. These and other factors are believed to be related to the etiopathogenesis of DR [ 4 ].…”

Bilateral Ocular Decompression Retinopathy after Ahmed Valve Implantation for Uveitic Glaucoma

“…ODR is a well-known complication that has been previously described in penetrating and nonpenetrating ocular surgeries such as trabeculectomy with or without antimetabolites, Ahmed valve implantation, anterior chamber paracentesis, vitrectomy, phacoemulsification, orbital decompression surgery, and less invasive procedures such as peripheral iridotomies and IOP-lowering medication [2, 3, 4, 5, 6, 7, 8, 9]. The mean drop of IOP reported is 33.2 ± 15.8 mm Hg (range, 4–57 mm Hg) [3].…”

Ocular decompression retinopathy following post-trabeculectomy suture lysis and management with triamcinolone acetonide

“…These haemodynamic changes cause retinal haemorrhages and macular oedema. ODR has been reported in juvenile open-angle glaucoma [1], and secondary open-angle glaucoma as angle-recession [2], uveitic [3], neovascular [4] and pseudoexfoliative [5] glaucoma. It has been reported as a complication of sudden lowering of IOP in angle-closure glaucoma [6].…”