AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

POSTERIOR UVEAL EFFUSION POST TRABECULECTOMY IN UNILATERAL INFANTILE GLAUCOMA: A CASE REPORT AND MANAGEMENT CHALLENGES

T.F. Sarimiye1 , A.S. Ata2 , and A.A. Olagunju

  1. Department of Ophthalmology, University of Ibadan and University College Hospital, Ibadan, Nigeria
  2. Department of Ophthalmology, University College Hospital, Ibadan, Nigeria.

ABSTRACT

Choroidal effusion is an abnormal collection of fluid within the suprachoroidal potential space. It is a common complication following glaucoma filtering surgeries such as trabeculectomy. It is a clinical diagnosis that sometimes goes undetected or unreported, except when symptomatic. Reported incident rates is 7.9 – 18.8% for serous effusions and 0.7 – 3% for haemorrhagic effusions. This report aims to highlight a case of choroidal effusion after trabeculectomy and its management challenges.

Case Report: A seven year old boy presented to our facility with history of cloudy appearance of the right eye of five years duration. He was diagnosed with right infantile glaucoma. Intraocular pressures (IOP) were 44mmHg and 18mmHg right and left eyes respectively. Patient subsequently had right trabeculectomy. He developed hypotony at post-operative day two and a right choroidal effusion was noticed at post-operative day four. As a result of this, he initially had a right anterior chamber reformation with ocular viscoelastic on day seven. Later, a compression suture over the bleb and sclerostomy was performed 11 days post initial surgery. Choroidal effusion progressively regressed post-operatively and completely resolved at day five post-sclerostomy and effusion drainage.

Conclusion: Choroidal effusion is a common complication after trabeculectomy in which conservative management results in resolution. However, when conservative management fails, surgical intervention should not be delayed to maximize good outcome. 

Keywords: Nebulize, Sore throat, Magnesium, Ketamine

Correspondence

Dr. A.S. Ata

Department of Ophthalmology,

University College Hospital,

Ibadan.

Email: dranibeata@yahoo.com


CASE REPORT

A 7 year old male presented on account of whitish speck noted in the right eye of about 5 years duration. There was a history of the right eye being slightly bigger than the left as well as poor vision in the right eye. There was no history of eye protrusion, abnormal skin pigmentation or seizures. There was no previous ocular surgeries, nil significant medical illnesses or previous hospitalization and no family history of glaucoma. 

Visual acuity was count fingers (CF) right eye and 6/5 left eye. Manifest refraction was +0.50DS/-2.75DC/ 80 right eye and +0.25DS left eye. A relative afferent pupillary defect (RAPD) was noted on the right eye. Applanation intraocular pressures were 44mmHg and 18mmHg in the right and left eye respectively. 

Slit lamp examination on the right eye showed a buphthalmic globe, Haab’s striae on the cornea with corneal diameter of 16.5 x 15.5mm, deep anterior chamber, round and sluggishly reactive pupil with RAPD, clear lens and cupped disc with a cup-to-disc (CDR) 1.0. Finding in the left eye were essentially normal with a pink disc of CDR 0.4.

An assessment of right infantile glaucoma was made and was temporarily commenced on anti-glaucoma medications (timolol and dorzolamide combination) for the right eye. He subsequently had right trabeculectomy with Mitomycin-C (MMC) under general anaesthesia. Notable intraoperative event was sudden shallowing of the anterior chamber upon entry. Postoperatively, he developed hypotony (an IOP of 0mmHg) with a huge bleb on the 2nd post-operative day and shallow anterior chamber with choroidal detachment observed on the 4th post-operative day (Fig. 1). 

An assessment of right overfiltration with choroidal effusion status post trabeculectomy was made. He initially had conservative management which included maximum cycloplegia and reduction of the frequency of topical steroid. This was to allow for deepening of the anterior chamber by pulling of the iris-lens diaphragm back and for some healing around the scleral flap and bleb to reduce the overfiltration. Upon failed conservative management, he had a right anterior chamber reformation with viscoelastic under general anaesthesia on post-operative day 7 to augment the conservative management. However, effusion worsened progressively, with vision of light perception (LP) and hypotony persisted as shown in figure 2 (a and b).

At the 11th day post-trabeculectomy, patient eventually had a right compression suture, repeat anterior chamber reformation with viscoelastic and sclerostomy with drainage of effusion under general anaesthesia.

Intraoperative findings include thick tenon capsule and sclera (which was unusual for an enlarged globe) and straw coloured suprachoroidal fluid was drained. Effusion resolved post-operatively with visual acuity of CF and the retina remained flat as shown in figure 3.