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Glaucoma surgery in a patient with prominent episcleral vessels
Author(s) -
PRIETO CALVO E,
DE LA MATA G,
FERNANDEZPEREZ S,
SATUE M,
GARCIAMARTIN E,
BAMBO MP,
PEREZOLIVAN S
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.f040.x
Subject(s) - medicine , glaucoma , intraocular pressure , trabeculectomy , gonioscopy , surgery , ultrasound biomicroscopy , glaucoma surgery , open angle glaucoma , ophthalmology
Abstract Purpose We report a case of a patient with dilated episcleral veins of unknown etiology and with secondary open angle glaucoma, who developed ciliochoroidal effusion as result of an early glaucoma filtration surgery. Methods Observational single case report. A 74‐year‐old male patient who had undergone sequential trabeculectomy for his both eyes, postoperatively he presented with redness of both the eyes and choroidal effusion, which was not resolved with conservative management (systemic steroid in tapering dose) or surgery. Slit‐lamp biomicroscopy revealed dilated episcleral veins and the gonioscopy showed open angles with blood in Schlemm’s canal in both eyes. Results During follow‐up, his intraocular pressure (IOP) remained in high thirties in the left eye (LE) and mid‐twenties in the right eye (RE) despite anti‐glaucoma medications and surgery. Systemic examination was negative for carotid cavernous fistula, low‐grade dural arteriovenous fistula, dysthyroid ophthalmopathy or orbital tumor. The chest X‐ray excluded any tumor at the apex of lung. Finally, the patient was admitted to the hospital for a right congestive heart failure and he was diagnosed with primary pulmonary hypertension (PPH) confirmed by physical examination, electrocardiogram and echocardiogram. Conclusion Secondary glaucoma related to dilated episcleral veins is difficult to manage medically and surgical complications are also high. The underlying mechanism by which PPH causes uveal effusion is an increased pressure in the superior vena cava transmitted to the ophthalmic veins and choroidal circulation that lead to the excessively dilated and congested episcleral veins observed in our patient.