CASE REPORT: A 74-year-old man who suffered from
primary open-angle glaucoma underwent his initial
trabeculectomy with
mitomycin-C in the right eye. Before the surgery, his intraocular pressure (IOP) was 20 to 22 mm Hg with
bimatoprost 0.03%,
dorzolamide 1%, and
brimonidine 0.1% and his best corrected visual acuity (BCVA) was 0.9. The mean deviation in Humphrey Visual Field Analyzer (24-2 program) was -27.83 db. After successful
trabeculectomy, IOPs were 11 to 16 mm Hg without any medication. Eight months after the surgery, we restarted
bimatoprost to further reduce the IOP in the right eye, which was 15 mm Hg. At a hospital visit 2 months later, he complained of blurred vision that had persisted for the past 1 month; his IOP had decreased to 9 mm Hg. His BCVA was 0.04 and 3 quadrant CD was found. We discontinued
bimatoprost and started him on
betamethasone 0.1% 4 times per day. However, CD marginally changed after 1 week, with IOP at 7 mm Hg; thus, we performed scleral drainage for CD. After 3 weeks of drainage, CD completely disappeared. IOP increased to 16 mm Hg and BCVA was 0.7. However, 3 months after the drainage, IOP increased to 29 mm Hg, and
needling revision was thus performed. After the surgery, IOP remained at 14 to 16 mm Hg without any
glaucoma medication and CD recurrence. A review of the literature showed that various
antiglaucoma medications induce CD, regardless of the preceding
glaucoma surgery and that CD is usually resolved by withdrawing the medication and administering topical
steroids. However, most previous studies have shown the recurrence of CD by rechallenging the same
drug.
CONCLUSION: In our case, topical
bimatoprost induced late-onset CD after
trabeculectomy. Early scleral drainage may be a good option to quickly resolve
drug-induced CD and prevent its recurrence. Therefore, it must be kept in mind that various
antiglaucoma medications induce CD.