Cessation of Recurrent Bilateral Optic Disc Haemorrhages after Successful Trabeculectomy: A Case Report

Case Report

J Ophthalmol & Vis Sci. 2023; 8(2): 1081.

Cessation of Recurrent Bilateral Optic Disc Haemorrhages after Successful Trabeculectomy: A Case Report

Ieva Laure; Franz Grehn; Christina Korb; Anna Beck; Alicja Strzalkowska; Bert C Giers; Katrin Lorenz

Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany

*Corresponding author: Katrin LorenzDepartment of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany. Tel: +49 6131 174069, Fax: +496131 175509 Email: katrin.lorenz@unimedizin-mainz.de

Received: February 17, 2023 Accepted: March 24, 2023 Published: March 31, 2023

Abstract

Purpose: To describe a patient with primary open-angle glaucoma in whom bilateral recurrent optic disc haemorrhages disappeared permanently after trabeculectomy.

Methods: A 67-old male patient was diagnosed with primary open-angle glaucoma and was followed for 10 years including best corrected visual acuity, visual field examinations, slit lamp examinations, Goldmann applanation tonometry, fundoscopy and optic disc photographs.

Results: Optic disc haemorrhages were detected in 8 out of 30 preoperative visits in the right eye and in 3 out of 19 visits in the left eye. Trabeculectomy with intraoperative application of mitomycin C was performed in both eyes due to the advanced visual field loss with an inadequate intraocular pressure control despite maximum-tolerated medical therapy and because of the recurrent optic disc haemorrhages. No further optic disc haemorrhages were observed in either eye after trabeculectomy.

Conclusion: Our case report demonstrates that recurrent bilateral optic disc haemorrhages can cease permanently after successful trabeculectomy.

Keywords: Primary open-angle glaucoma; Optic disc haemorrhage; Intraocular pressure; Progression.

Introduction

Glaucoma is a leading cause of blindness and represents a group of ocular disorders characterized by progressive loss of retinal ganglion cells and their axons. This optic nerve degeneration results in gradual loss of visual field, which may ultimately lead to blindness [1-3]. The pathogenesis of glaucoma is only partially understood. Elevated Intraocular Pressure (IOP) is the most relevant risk factor for disease development or progression and presently the only therapeutically addressable factor [4-8]. Previous studies have shown that optic disc haemorrhages can also be an important risk factor for the progression of glaucoma [9-11]. Nevertheless, the explanation of this observation is still unclear. In addition, the theories of the pathogenesis of optic disc haemorrhages vary considerably. A new approach supports the hypothesis that optic disc haemorrhages are induced by arterial sources and are connected with vascular dysregulation [12]. The latest optical coherence tomography studies found a significant association between the occurrence of optic disc haemorrhages and the focal defects of the lamina cribrosa [13,14]. Lee et al. [15] have suggested a new mechanism, where the reactive gliosis in glaucoma can form fibrous glial scars that can disrupt the vascular wall and lead to the formation of optic disc haemorrhages. To the best of our knowledge, there is only one study mentioned in the literature so far, that evaluates the effect of surgical reduction of intraocular pressure on the recurrence of optic disc haemorrhages [16]. Our case report demonstrates that recurrent bilateral optic disc haemorrhages can cease after successful bilateral trabeculectomy.

Case Presentation

In 2013, a 67 years old white male was diagnosed with Primary Open-Angle Glaucoma (POAG) in our department during a routine examination. The patient was followed-up for 10 years until 2022. A total of 52 ophthalmologic examinations were performed in this patient. There were 19 follow-up examinations prior to trabeculectomy in the left eye and 30 prior to the trabeculectomy in the right eye.

In the beginning his decimal visual acuity was 1.0 in the right eye and 0.8 in the left eye. Visual field examinations were performed with the Humphrey Field Analyzer using the SITA (Swedish Interactive Threshold Algorithm) standard central 24-2 threshold test. The MD values varied during the entire follow-up period (right eye: -11.42dB to -12.97dB in 2013 to -13.52dB in 2022; left eye: -12.73dB to -14.45dB in 2013 to -24.28dB in 2022) and revealed typical advanced glaucomatous visual field defects (Figure 1).