Retinal Detachment during Glaucoma Therapy

Abstract

Miotic-induced retinal detachment (RD) is a condition that is not recognized as such by common consent. Clinically it has been shown that all miotic agents, whether strong or weak, can precipitate an RD, if there are additional contributing factors like high myopia, peripheral lattice degeneration of the retina, pathological vitreoretinal changes and previous history of an RD in the other eye, which all increase the basic risk of RD. Pilokarpin lameller 11 mg® represents a form of miotic therapy having initially only a moderate accommodative and miotic effect, which further declines to a level of steady state during the next hours. Because the time interval after which a new Pilokarpin lameller unit is required lasts up to 1 week, the total amount of accommodation and miosis is much smaller than when applying daily 2% pilocarpine drops. However, it seems important, before the start of any kind of miotic therapy, to perform a careful examination and management of virtually all detachment-prone patients. This case report deals with an RD which occurred after 2 days of treatment with Pilokarpin lameller (Ocusert®) 11 mg in a myopic patient who had a juvenile type of glaucoma and previous history of an RD in the other eye.

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“…Although no large prospective studies have been conducted that have proven a causal relationship between topical pilocarpine and retinal detachment, numerous case reports suggest a potential increase in the risk of retinal detachment with pilocarpine eye drops for glaucoma patients, as well as with Vuity for presbyopia [ 5 , 7 , 8 , 19 ]. The earliest description of retinal detachment in a patient with miotic medications (topical eserine) was reported by Leber in 1877 [ 20 ].…”

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“…16,17 Cholinergic agonists (eg Pilocarpine) increase conventional aqueous outflow, however are less commonly used than other classes due to their poorly tolerated side effect profile, including myopic shift, nyctalopia, and increased risk of retinal tears and detachment. [18][19][20][21][22]…”