Delhi Journal of Ophthalmology

Cup Reversal in a Steroid Responder Post-Trabeculectomy

Jayamadhury Gudimetla, Vinaya Kumar Konana, Sudhakar Potti, Madhu Kumar R, Ashok Kanakamedla, Swarnalatha Poluri
Sankara Eye Hospital, Guntur, Andhra Pradesh, India

Corresponding Author:

Jayamadhury Gudimetla DNB
Sankara Eye Hospital, Guntur – Vijayawada
Express Highway, Pedakakani, Guntur,
Andhra Pradesh - 522509, India
Email id: drjayamadhury@gmail.com

Received: 14-OCT-2018

Accepted: 21-JAN-2019

Published Online: 05-MAY-2019

DOI:http://dx.doi.org/10.7869/djo.460

Abstract
An 18 year old male presented with diminution of vision in right eye since 4 days. Fundus of the right eye examination revealed a cup disc ratio of 0.4:1 and occlusion of superior and inferior branch retinal vein. The patient received sub tenon Triamcinolone acetonide elsewhere in the right eye. On follow up visit IOP was 48 mm of Hg and the cup disc ratio was 0.7:1 in right eye. The patient was started on maximum anti-glaucoma medications despite which the IOP was not under control. Patient underwent trabeculectomy in the right eye. One month post trabeculectomy, the cup disc ratio decreased from 0.7:1 to 0.4:1 and the IOP was 10 mm of Hg. Our case reemphasizes that prompt treatment of young patients with raised IOP can achieve cup reversal.

Keywords :Cup, Reversal, Steroid, Trabeculectomy



An 18 year old male presented with diminution of vision in the right eye since 4 days. The patient had history of subnormal vision in the left eye following trauma. The best corrected visual acuity (BCVA) was counting fingers at 2 meters in right eye and 6/6 in the left eye, intraocular pressure (IOP) was 
8 mm of Hg in right eye and 10 mm of Hg in the left eye. Anterior segment examination was unremarkable in both eyes. The right eye fundus examination revealed a cup disc ratio of 0.4:1, multiple superficial haemorrhages and tortuous veins in the supero and inferotemporal quadrants with macular edema. The left eye fundus examination was normal. Infective causes and hypercoagulability disorders were ruled out. The patient was advised intravitreal Bevacizumab in the right eye. The patient was lost to follow up for 3 months and, had received sub tenon Triamcinolone acetonide elsewhere in the right eye, one month prior to the next consultation. On examination his BCVA in the right eye was 6/18 and IOP was 48 mm of Hg. The cup disc ratio was 0.7:1 in the right eye. The patient was started on maximum anti-glaucoma medications inspite of which IOP was not under control. The patient underwent trabeculectomy with Mitomycin C 0.02% in the right eye. One month post trabeculectomy, BCVA in the right eye was 6/18, the cup disc ratio decreased from 0.7:1 to 0.4:1 and the IOP was 10 mm of Hg. Cup reversal post trabeculectomy has been reported in the literature especially in the young.1,2 It has been postulated that the cup reversal is due to backward bowing of lamina cribrosa and changes in the scleral biomechanics like axial length and optic disc size.3,4 Our case reemphasizes that prompt treatment of young patients with raised IOP can achieve cup reversal.



References

1. Wu SC, Huang SC, Kuo CL, Lin KK, Lin SM. Reversal of optic disc cupping after trabeculotomy in primary congenital glaucoma. Can J Ophthalmol 2002; 37:337-341.
2. Lesk MR, Spaeth GL, Azuara-Blanco A, Araujo SV, Katz LJ, Terebuh AK, et al. Reversal of optic disc cupping after glaucoma surgery analyzed with a scanning laser tomograph. Ophthalmology. 1999;106:1013-1018.
3. Sigal IA, Flanagan JG Tertinegg I, Ethier CR. Predicted extension, compression and shearing of optic nerve head tissues. Exp Eye Res 2007; 85:312-322.
4. Kakutani Y, Nakamura M, Nagai-Kusuhara A, Kanamori A, Negi A. Marked Cup Reversal Presumably Associated With Scleral Biomechanics in a Case of Adult Glaucoma. Arch Ophthalmol 2010; 128:139–141. 


CITE THIS ARTICLE

Jayamadhury Gudimetla, Vinaya Kumar Konana, Sudhakar Potti, Madhu Kumar R, Ashok Kanakamedla, Swarnalatha PoluriCup Reversal in a Steroid Responder Post-Trabeculectomy.DJO 2019;29:106-107

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Jayamadhury Gudimetla, Vinaya Kumar Konana, Sudhakar Potti, Madhu Kumar R, Ashok Kanakamedla, Swarnalatha PoluriCup Reversal in a Steroid Responder Post-Trabeculectomy.DJO [serial online] 2019[cited 2019 Nov 21];29:106-107. Available from: http://www.djo.org.in/articles/29/4/Cup-Reversal-in-a-Steroid-Responder-Post-Trabeculectomy.html