Visual improvement following glaucoma surgery: a case report.

William S Foulsham,Lanxing Fu,Andrew J Tatham

doi:10.1186/1471-2415-14-162

Abstract

BackgroundGlaucoma is a progressive optic neuropathy and a leading cause of blindness. Neural losses from glaucoma are irreversible, and so the aim of glaucoma treatment is to slow progression and minimize the risk of further damage. Functional improvement with treatment is not expected. We report the case of a patient who experienced a significant improvement in vision following glaucoma surgery and review the literature regarding this phenomenon.Case presentationA 64-year old male presented with a 13-month history of gradual vision loss in the right eye to the extent that he could only perceive hand movements. His intraocular pressure (IOP) measured 50 mmHg and he was found to have advanced primary open angle glaucoma. Medical treatment was commenced and he underwent a successful right Mitomycin C-augmented trabeculectomy. Unexpectedly he experienced marked improvement in vision post-operatively, with improvements maintained through six months of follow-up. At his most recent visit visual acuity was 6/18 in the affected eye. Although the mechanism of improved vision cannot be proven it is likely that successful lowering of IOP resulted in some reversal of retinal ganglion cell dysfunction. Important factors may have included his relatively young age, high IOP and short duration of symptoms.ConclusionAlthough rare, functional improvements may occur following trabeculectomy. Glaucoma surgery should be offered early to those with advanced disease, and considered even in those with reduced visual acuity.

Highlights

Glaucoma is a progressive optic neuropathy and a leading cause of blindness
The patient described in this case had severe glaucomatous damage at presentation, evident from the marked loss of neural tissue seen on optic disc examination, the presence of extreme thinning of retinal nerve fiber layer (RNFL) on Optical coherence tomography (OCT), and the severe functional deficit, with a visual acuity of only hand movements and a relative afferent pupillary defect
In conclusion, glaucomatous damage is deemed irreversible, our patient experienced a significant improvement in vision following successful reduction in intraocular pressure (IOP)

Summary

Introduction

Glaucoma is a progressive optic neuropathy and a leading cause of blindness. Neural losses from glaucoma are irreversible, and so the aim of glaucoma treatment is to slow progression and minimize the risk of further damage. Case presentation: A 64-year old male presented with a 13-month history of gradual vision loss in the right eye to the extent that he could only perceive hand movements. His intraocular pressure (IOP) measured 50 mmHg and he was found to have advanced primary open angle glaucoma. Medical treatment was commenced and he underwent a successful right Mitomycin C-augmented trabeculectomy He experienced marked improvement in vision post-operatively, with improvements maintained through six months of follow-up. There was a positive family history of glaucoma, with the patient’s older sister being diagnosed at age 52, she had not required surgery or developed significant visual impairment

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