First Author: E.Kanonidou GREECE
Co Author(s): E. Kanonidou I. Salonikiou P. Kikas F. Lahanas G. Sakkias 0 0 0 0 0 0 0 0 0
Back to previous
To present an interesting case of primary open angle glaucoma with intraocular pressure control failure due to topical antiglaucomatous drugs side effects and to highlight the dilemmas regarding the therapeutic management.
Department of Ophthalmology, ‘’Hippokrateion’’ General Hospital of Thessaloniki, Thessaloniki, Greece
Male patient aged 78 years with primary open angle glaucoma (c/d ratio 0.8) present at the outpatient Ophthalmology department due to blurred vision, photophobia, eye irritation. The patient had a good intraocular pressure control during the last 7 years with topical administration of fixed combination of timolol+brimonidine, brinzolamide and latanoprost and underwent uneventful cataract surgery bilaterally. The ophthalmological examination revealed anterior uveitis with corneal precipitates bilaterally while the intraocular pressure was within the target pressure (RE: 13mmHg, LE:12mmHg).
Latanoprost was discontinued, the patient was treated with topical administration of dexamethazone and then loteprednole with improvement of the intraocular inflammation but with intraocular pressure elevation (RE:19mmHg, LE:21mmHg) which was controlled with per os acetazolamide. Τhe patient was released with his previous antiglaucoma medication, replacement of latanoprost with bimatorpost, discontinuation of acetazolamide and good intraocular pressure control in subsequent measurements. A month later, the patient was presented again with symptoms and signs of anterior uveitis and elevated intraocular pressure which was controlled with discontinuation of the prostamide, topical administration of steroids and per os acetazolamide. Because of the free medical history and the normal laboratory diagnostic tests, the ocular condition was attributed to topical administration of the prostaglandin/prostamide and the patient underwent surgery (trabeculectomy) with satisfactory intraocular pressure control (12mmHg).
The topical antiglaucoma treatment remains the gold standard regarding the management of patients with glaucoma despite the side effects which may affect compliance and puzzle the doctor. In some cases, surgical intervention is the preferable solution. Special attention should be given to the patients’ information with regards to the benefits and drawbacks of treatment both with topical medication as well as with surgical intervention.