title: Consecutive bilateral decompression retinopathy after mitomycin C trabeculectomy: a case report.
abstract: BACKGROUND
  After a successful trabeculectomy, a sudden intraocular pressure decrease may alter the intracranial to intraocular pressure ratio and cause decompression retinopathy. Frequent Valsalva maneuvers may also play a role in its pathogenesis. This condition may manifest as multiple retinal hemorrhages, edema of the optic disc, macular edema, or a sudden decrease in visual acuity postoperatively. Outcomes for patients are usually good, with spontaneous resolution occurring within a matter of weeks. It has been rarely reported in the literature as a bilateral condition.
  
  
  METHODS
  We present a case of consecutive bilateral decompression retinopathy in a 54-year-old severely obese Caucasian woman (body mass index 37 kg/m(2)) with open angle glaucoma and a poor history of medical therapeutic compliance, who chose surgical treatment based on her inability to consistently use ocular drops. Our patient underwent a trabeculectomy with mitomycin C in both eyes, with surgeries taking place 3 months apart. After the first surgery, 2 weeks postoperatively, she complained of decreased visual acuity. Examination of her right eye fundus revealed multiple retinal hemorrhages and disc edema. There was a similar pattern in her left eye, this time including maculopathy. Her visual acuity and fundoscopic changes resolved spontaneously over a period of a month in both cases. Currently, our patient has well-controlled bilateral intraocular pressure, ranging between 14 and 16 mmHg, without hypotensive medication.
  
  
  CONCLUSIONS
  Decompression retinopathy is a potential complication after glaucoma surgery, but has rarely been described as a bilateral consecutive condition. A comprehensive approach could help to anticipate its occurrence and manage it.
authors: Ophthalmology Department - Centro Hospital do Porto, EPE - Hospital de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal. anamarcosfigueiredo@gmail.com.
authors: Ana Raquel Marcos
authors: ARM
authors: Figueiredo
authors: Ophthalmology Department - Centro Hospital do Porto, EPE - Hospital de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
authors: Isabel Coutinho
authors: IC
authors: Sampaio
authors: Ophthalmology Department - Centro Hospital do Porto, EPE - Hospital de Santo António, Largo Professor Abel Salazar, 4099-001, Porto, Portugal.
authors: Maria João Fernandes Dos Santos
authors: MJFDS
authors: Menéres
authors: Wills Eye Hospital, Jefferson Medical College, 840 Walnut Street, Philadelphia, PA, 19107, USA.
authors: George L
authors: GL
authors: Spaeth
mesh_terms: D003432:Cross-Linking Reagents / Q000627:therapeutic use; D003664:Decompression; D005260:Female; D005902:Glaucoma, Open-Angle / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D016685:Mitomycin / Q000627:therapeutic use; D010211:Papilledema / Q000209:etiology; D012164:Retinal Diseases / Q000209:etiology*; D012166:Retinal Hemorrhage / Q000209:etiology; D014130:Trabeculectomy / Q000009:adverse effects*
chemical_list: D003432:Cross-Linking Reagents; D016685:Mitomycin