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Bilateral choroidal effusion after selective laser trabeculoplasty
Desprendimiento coroideo seroso bilateral tras trabeculoplastia selectiva láser
F. Hernández Pardines
Corresponding author
oftalmofer@yahoo.es

Corresponding author.
, J.C. Molina Martín, L. Fernández Montalvo, F. Aguirre Balsalobre
Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
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after SLT in both eyes is described&#46; Only Kim and Singh reported a similar case but with unilateral expression&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Female&#44; 73&#44; who consulted for intraocular pressure checkup&#46; Pathological ocular history included primary open angle glaucoma in both eyes &#40;BE&#41; in treatment with Ganfort<span class="elsevierStyleSup">&#174;</span> &#40;bimatoprost&#47;timolol 0&#46;3&#47;5<span class="elsevierStyleHsp" style=""></span>mg&#47;ml&#59; Allergan&#44; S&#46;A&#46;&#59; Tres Cantos&#44; Madrid&#44; Spain&#41; and Alphagan<span class="elsevierStyleSup">&#174;</span> &#40;0&#46;2&#37; brimonidin tartrate&#59; Allergan&#44; S&#46;A&#46;&#59; Tres Cantos&#44; Madrid&#44; Spain&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination showed visual acuity &#40;VA&#41; 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dexamethasone&#44; Alcon Cus&#237;&#44; S&#46;A&#46;&#44; El Masnou&#44; Barcelona&#44; Spain&#41; was prescribed to be taken at 4-hour intervals&#44; and Betoptic<span class="elsevierStyleSup">&#174;</span> &#40;0&#46;5&#37; betaxolol hydrochloride&#59; Alcon Cus&#237;&#44; S&#46;A&#46;&#44; El Masnou&#44; Barcelona&#44; Spain&#41; every 12<span class="elsevierStyleHsp" style=""></span>h during one week&#44; and Simbrinza<span class="elsevierStyleSup">&#174;</span> every 12<span class="elsevierStyleHsp" style=""></span>h &#40;brimonidin tartrate&#44; brinzolamide 10&#47;2<span class="elsevierStyleHsp" style=""></span>mg&#47;ml&#59; Alcon Cus&#237;&#44; S&#46;A&#46;&#59; Barcelona&#44; Spain&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Twenty-four hours after the SLT&#44; the patient appeared at the Emergency Dept&#46; referring diminished vision in BE&#46; VA was 20&#47;25 in the RE and 20&#47;50 in the LE&#44; IOP with applanation of 6 and 8<span class="elsevierStyleHsp" style=""></span>mmHg respectively&#44; narrow anterior chamber in BE &#40;1&#46;9<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; diffuse ciliary hyperemia&#44; cellularity and AC &#40;tyndall&#41; 3&#43; as per the International Group for Standardization of Uveitis Nomenclature &#40;SUN&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> bilateral peripheral serous CD 360&#176; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Duplex ocular echography &#40;mode A&#47;mode B&#41; confirmed the diagnostic of bilateral serous CD &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; that showed medium hyper-reflectiveness &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41; at the level of the detached choroids&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Simbrinza<span class="elsevierStyleSup">&#174;</span> was suspended and Maxidex<span class="elsevierStyleSup">&#174;</span> was prescribed at one-hour intervals&#44; and Colicurs&#237; Atropina<span class="elsevierStyleSup">&#174;</span> &#40;1&#37; atropine sulfate&#59; Alcon Cus&#237;&#44; S&#46;A&#46;&#44; El Masnou&#44; Barcelona&#44; Spain&#41; every 8<span class="elsevierStyleHsp" style=""></span>h and 60<span class="elsevierStyleHsp" style=""></span>mg oral prednisone per day&#46; One week later&#44; CD had resolved entirely &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41; with VA of 20&#47;30 in BE&#46; IOP was 40<span class="elsevierStyleHsp" style=""></span>mmHg in the RE&#44; for which reason Simbrinza<span class="elsevierStyleSup">&#174;</span> was resumed&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient maintained high IOP in BE which could not be controlled with maximum medical treatment&#44; for which reason it was decided to perform non-perforating deep sclerectomy with Esnoper V2000<span class="elsevierStyleSup">&#174;</span> scleral implant &#40;Hidroxyethyl Metacrilate &#91;HEMA&#93;&#59; AJL Ophthalmic&#59; &#193;lava&#44; Spain&#41;&#59; first in the RE and one month later in the LE&#46; At present&#44; IOP is 14<span class="elsevierStyleHsp" style=""></span>mmHg in the RE and 15<span class="elsevierStyleHsp" style=""></span>mmHg in the LE&#44; without concomitant medication&#44; and a VA of 20&#47;20 in BE&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">In theory&#44; SLT produces a thermal call that gives rise to the production of cytokins from the trabecular mesh&#46; These cytokins include interleukin-alpha &#40;IL-1&#41;&#44; interleukin-1 beta &#40;IL-1&#946;&#41;&#44; and tumor necrosis factor alpha &#40;TNF-&#945;&#41;&#46; The result is the recruitment of macrophages that ingest detritus in the extracellular matrix of the trabecular mesh&#46; In addition&#44; lipidic peroxidase increases and free radical scanning is diminished due to superoxide dismutase and gluthathione-S-transferase in the aqueous humor&#44; suggesting a formation of free radicals capable of producing post-surgery inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">It has been demonstrated that patients that utilize bimatoprost exhibit significantly higher levels of IL-1&#946; and TNF-&#945; in their tears&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> In the present case&#44; the patient utilized bimatoprost before SLT&#44; which could have contributed to activate said inflammation pathway&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The exact mechanism of CD is unknown&#46; It has been proposed that a sudden IOP drop&#44; together with increased transmural pressure in the vascular choroidal plexus&#44; could be the cause&#46; Even so&#44; it is considered that ocular inflammation plays an important role in the physiopathology of CD as it increases vascular permeability enabling the passage of serum carrying large proteic molecules into the suprachoroidal space&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The authors report the case of a patient with open angle glaucoma who had bilateral serous CD after SLT in BE&#46; Reviewing the literature&#44; the only finding was a single case of serous CD secondary to SLT published by Kim and Singh&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> In said case&#44; CD was unilateral in a patient with a vitrectomized eye in treatment with Cosopt<span class="elsevierStyleSup">&#174;</span> &#40;Merck Sharp &#38; Dohme&#44; S&#46;A&#46;&#44; Madrid&#44; Spain&#41; who exhibited inflammatory reaction 2 weeks after treatment&#46; In addition&#44; the energy applied by Kim and Singh was nearly twice that applied in the present case &#40;in addition to being applied at 360&#176; in contrast with the 180&#176; in the reported case&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Reviewing the literature&#44; the authors found an article published by Kennedy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> who treated an open angle chronic glaucoma patient with argon laser trabeculoplasty with the following parameters&#58; 270&#176; inferior to the angle with 82 shots of 0&#46;2<span class="elsevierStyleHsp" style=""></span>s&#44; spot diameter of 50 microns and a power of 1&#46;0<span class="elsevierStyleHsp" style=""></span>Watts&#46; The patient consulted 3 weeks later exhibiting IOP of 2<span class="elsevierStyleHsp" style=""></span>mmHg in the LE and a vision of 6&#47;36&#44; with significant narrowing of the AC&#46; In the present case&#44; the patient consulted 24<span class="elsevierStyleHsp" style=""></span>h after SLT upon appearance of symptoms&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">It is worthy of note that in the present patient SLT was performed bilaterally in the same session&#46; Phillis and Bourke<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> reported a case with intermittent ocular hypertension history &#40;OHT&#41; without previous topical treatment and acute vision loss in BE 12<span class="elsevierStyleHsp" style=""></span>h after undergoing bilateral SCT in inferior 180&#176; of BE&#46; Post-SLT OCT showed retina pigment epithelium detachment in the RE and foveal serous detachment in the LE&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">As conclusion&#44; despite the fact that SLT is a safe technique&#44; it is not completely innocuous&#46; Possible complications derived from SLT include increased IOP&#44; iritis&#44; hyphema&#44; macular edema&#44; corneal haze and refraction changes without forgetting the possible appearance of uni- or bilateral serous CD&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Selective laser trabeculoplasty &#40;SLT&#41; is an effective treatment to treat open-angle glaucoma with a low risk of complications&#46; The case is presented of a 73 year-old woman with uncontrolled primary open-angle glaucoma who underwent selective laser trabeculoplasty in both eyes and developed bilateral choroidal effusion&#46;</p></span>"
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Article information
ISSN: 21735794
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos