Abstract
We report a case of bimatoprost induced serous macular detachment and choroidal folds following uneventful cataract surgery. A 66-year-old male using topical bimatoprost in both eyes for open angle glaucoma underwent uneventful cataract surgery in the right eye. Postoperatively, he was restarted on topical bimatoprost and antibiotic-steroids combination drops. One week after surgery, he presented with conjunctival hyperemia, serous macular detachment, and choroidal folds at the posterior pole. Fundus fluorescein angiography showed perifoveal leaks in early stage with pooling of dye in late stage. Discontinuation of bimatoprost led to resolution of serous detachment and choroidal folds within 3 weeks with significant improvement in visual acuity. Occurrence of serous macular detachment and choroidal folds in this case could be probably related to the proinflammatory property of bimatoprost. Hence, it should be used with caution in the immediate postoperative period after cataract surgery.
Highlights
Bimatoprost is a synthetic prostamide with ocular hypotensive effect acting on the uveoscleral pathway [1]
We considered serous macular detachment (SMD) and choroidal folds probably as a side effect of bimatoprost and it was stopped and replaced by topical timolol 0.5% twice a day and topical antibiotics-steroid combination was continued at 4 times a day
In a situation like recent cataract surgery which is associated with breakdown of blood-aqueous barrier due to the release of various inflammatory mediators including prostaglandins, even low concentration doses required for ocular hypotensive response can further affect the vascular permeability
Summary
Bimatoprost is a synthetic prostamide with ocular hypotensive effect acting on the uveoscleral pathway [1] It triggers a cascade of tissue remodeling enzymes, such as metalloproteinases and transcription factors such as c-Fos, thereby degrading collagen. Prostaglandin analogs are prescribed as first-line and first-choice treatment for glaucoma patients with good compliance due to single dose daily regimen. Though it has good IOP lowering capacity, it is associated with few side effects like conjunctival hyperemia, increased pigmentation in the periocular skin and iris, hypertrichosis, increased severity and recurrence of herpetic keratitis, and cystoid macular edema [2]. We here report bimatoprost induced serous macular detachment following uneventful cataract surgery in an adult with primary open angle glaucoma
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