Bilateral choroidal effusion after selective laser trabeculoplasty

Pardines, F. Hernández; Martín, J.C. Molina; Montalvo, L. Fernández; Balsalobre, F. Aguirre

doi:10.1016/j.oftale.2017.03.016

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…The present report describes a patient who experienced choroidal detachment accompanied by hypotony following SLT. Two cases of choroidal effusion after SLT have been reported previously, however, these are all related with severe iritis [ 12 , 13 ]. To our knowledge, this is the first report of hypotony and choroidal detachment without inflammation after SLT.…”

Section: Discussionmentioning

confidence: 99%

Choroidal detachment and hypotony following selective laser trabeculoplasty: a case report

et al. 2023

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Background Selective laser trabeculoplasty (SLT) is relatively safe and effective in lowering intraocular pressure (IOP). However, although rare, complications can occur after SLT. This report describes a patient with choroidal detachment due to hypotony following SLT without anterior chamber (AC) inflammation. Case presentation A 67-year-old man was referred for elevated IOP in his left eye with advanced glaucomatous visual field loss. He had previously been diagnosed with idiopathic uveitic glaucoma in the left eye, for which he underwent laser iridotomy, trabeculectomy, and cataract surgery. At the first visit, the IOP of his left eye measured by Goldmann tonometry was 28 mmHg despite maximally tolerated medical treatment. SLT was performed in his left eye, resulting in an IOP of 7 mmHg 7 days later. At 3 weeks post-procedure, the patient experienced ocular pain and decreased visual acuity in his left eye. Slit-lamp examination revealed deep anterior chamber depth and no inflammation reaction, but the IOP in his left eye was 4 mmHg, and both fundus and B-scan ultrasonography showed serous choroidal detachment. All anti-glaucoma agents were stopped, and the patient was started on treatment with oral prednisolone and cyclopentolate eye drops. Three weeks later, choroidal detachment had resolved and the IOP in his left eye had stabilized at 8 mmHg. Follow-up 3 months later showed that the IOP in his left eye remained stable. Conclusions Choroidal detachment-related hypotony is a rare complication of SLT. This possible complication following SLT should be informed to the patients and considered when performing the procedure.

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Section: Discussionmentioning

confidence: 99%

Choroidal detachment and hypotony following selective laser trabeculoplasty: a case report

et al. 2023

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“…[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.…”

Section: Subconjunctival Space: Subconjunctival Filtrationmentioning

confidence: 99%

Minimally Invasive Surgery, Implantable Sensors, and Personalized Therapies

Gillmann¹,

Mansouri

2020

JOVR

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Glaucoma management has changed dramatically over the last decades, through clinical advances and technological revolutions. This review discusses the latest innovations and challenges faced in the field around three major axes: minimally-invasive glaucoma surgery (MIGS), implantable sensors and injectable therapeutics. Indeed, the vast number of recently developed MIGS techniques has not only provided clinicians with a wide range of therapeutic options, but they have also enabled them to adjust their therapies more finely which may have contributed a more patient-centric decision-making process. Yet, despite considerable advances in the field, the wide heterogeneity in clinical trial designs blurs the surgical outcomes, specificities and indications. Thus, more high-quality data are required to make the choice of a specific MIGS procedure more than an educated guess. Beyond the scope of MIGS, the potential of IOP telemetry for self-assessment of IOP-control through implantable sensors is developing into a real option for clinicians and an empowering opportunity for patients. Indeed, providing patients with direct feedback enables them to take control and have a clearer representation of their care, in turn leading to a better control of the disease. However, there are potential issues with self-monitoring of IOP, such as increased anxiety levels induced by measured IOP fluctuations and peaks, leading to patients self-treating during IOP spikes and additional office visits. Furthermore, the advent of implantable therapeutics may soon provide yet another step towards personalized glaucoma treatment, by offering not only an efficient alternative to current treatments, but also a therapeutic option that may better adapt to patients’ lifestyle. After several decades of relative stagnation through the last century, glaucoma has now entered what many view as a golden age for the specialty. Like every revolution, this one brings its fair share of uncertainty, clinical questioning and uneasy periods of adaptation to ever-changing expectations. Yet, while it is impossible to guess what the landscape of glaucoma surgery will be like in ten or fifteen years, data suggest a bright outlook both for patients and clinicians. Keywords: Glaucoma; MIGS; Quality of Life; Telemetry; Eyemate; Bimatoprost SR

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“…Most of the complications associated with SLT are transient and self-limiting. These include anterior chamber inflammation(90), IOP spikes(91), transient corneal endothelial changes or stromal haze(92,93) and retinal changes including cystoid macular oedema(94)(95)(96), development of subretinal fluid(97) and post SLT choroidal effusions(98,99). Unlike ALT, the development of peripheral anterior synechiae (PAS) is not common post SLT.In their meta-analysis, Wong et al described only 2.86% of cases developed PAS(100) though it has been described to occur after repeat SLT(101).Direct comparison between SLT studies is difficult.…”

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confidence: 99%

Treatment choices for newly diagnosed primary open angle and ocular hypertension patients

Garg

Gazzard

2019

Eye

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Despite advances in our knowledge of the aetiology and pathophysiology of glaucoma, the sole proven, effective intervention for treating primary open angle glaucoma (POAG) and ocular hypertension (OHT) remains lowering of intraocular pressure (IOP) to prevent further progression and visual loss. The purpose of this review is to evaluate the treatment choices available to newly diagnosed POAG and OHT patients. We review the existing literature on current treatments available for newly diagnosed POAG and OHT patients and discuss their role in the treatment paradigm of POAG and OHT. We also consider different factors that may be important when offering a choice of treatment to newly diagnosed POAG and OHT patients. We describe new glaucoma treatments in development and future directions for treatment.

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Bilateral choroidal effusion after selective laser trabeculoplasty

Cited by 4 publications

References 9 publications

Choroidal detachment and hypotony following selective laser trabeculoplasty: a case report

Choroidal detachment and hypotony following selective laser trabeculoplasty: a case report

Minimally Invasive Surgery, Implantable Sensors, and Personalized Therapies

Treatment choices for newly diagnosed primary open angle and ocular hypertension patients

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