Acute Angle-Closure Attack Associated with Travoprost Induced Uveal Effusion in A Nanophthalmic Eye – A Case Report

Abstract

Purpose: To report a case of acute angle-closure attack associated with travoprost-induced uveal effusion in a nanophthalmic eye even with a patent iridotomy.Methods: A case report.Results: A 70-year-old man with the history of nanophthalmos and acute angle-closure attack in the right eye (RE) received laser iridotomies in both eyes and received a fixed combination of timolol maleate 0.5% and dorzolamide HCl 2% twice per day in the RE after the episode. Intraocular pressure (IOP) was stable with the medication until bradycardia was noted. Travoprost 0.004% once daily in the RE was used. Four days later, foggy vision (20/400) and significant IOP elevation (69 mm Hg) were found in the RE. Oral acetazolamide 500 mg and intravenous mannitol 20% 300 mL were given emergently. The topical anti-glaucomatous agent was shifted from travoprost 0.004% to pilocarpine 2% four times per day, dorzolamide HCl 2% and brimonidine tartrate 0.15% three times per day. The ultrasound biomicroscopy (UBM) showed circumferential uveal effusion. Four weeks later, uveal effusion was completely resolved. The IOP was adequately controlled with dorzolamide 2% only in the RE.Conclusion: In a nanophthalmic eye, travoprost-enhanced uveoscleral outflow would result in uveal effusion. The forward shifting of the lens secondary to choroidal expansion might narrow the anterior chamber angle and lead to acute angle-closure attack. Travoprost should be used with caution in patients with nanophthalmos.