Abstract
IntroductionCorticosteroid therapy is a first-choice treatment for anti-aquaporin 4 antibody-positive neuromyelitis optica. Although we expected corticosteroid-induced glaucoma as a potential complication of the therapy, there are no reports in the literature describing it. In this report, we describe a case of successful trabeculotomy performed on a patient with corticosteroid-induced glaucoma and anti-aquaporin 4 antibody-positive neuromyelitis optica.Case presentationA 40-year-old Japanese woman who was given prednisolone orally after the diagnosis of anti-aquaporin 4 antibody-positive neuromyelitis optica experienced acute, painful loss of vision in her right eye. Although her right eye intra-ocular pressure was increased, we considered the main cause of her recent visual disturbance to be neuromyelitis optica because her right eye visual acuity declined to no light perception within a short period with a marked central scotoma. We treated our patient with high-dose methylprednisolone and double-filtration plasmapheresis; however, no improvement was observed. After we performed trabeculotomy in her right eye, our patient’s post-operative intra-ocular pressure was maintained within the normal range. Her visual acuity drastically improved soon after the decrease of intra-ocular pressure.ConclusionsBoth neuromyelitis optica and glaucoma caused our patient’s visual disturbance, and clinicians should plan for treatment of both neuromyelitis optica and glaucoma in such cases.
Highlights
Corticosteroid therapy is a first-choice treatment for anti-aquaporin 4 antibody-positive neuromyelitis optica
Intravenous and oral corticosteroid therapies are commonly used to treat anti-aquaporin 4 antibody-positive neuromyelitis optica (NMO), and plasmapheresis is beneficial for patients with acute, severe vision loss who have optic neuritis that is refractory to corticosteroid therapy [1,2]
Our patient’s right best-corrected visual acuity (BCVA) radically declined to no light perception in a short period of time and was accompanied by central scotoma, and we initially considered the main cause of her visual disturbance to be anti-aquaporin 4 antibody-positive NMO rather than corticosteroidinduced glaucoma
Summary
Corticosteroid therapy is a first-choice treatment for antiaquaporin 4 antibody-positive NMO, and corticosteroidinduced glaucoma is a potential complication of this therapy. Both NMO and glaucoma caused our patient’s visual disturbance, and clinicians should plan for the treatment of both NMO and glaucoma. Consent Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions MK analyzed and interpreted the patient data. MZ was a major contributor in writing the manuscript. Both authors read and approved the final manuscript
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