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Cynthia X. Qian, Jean-Daniel Arbour; Long-term Topical Corticosteroid Treatment For Unilateral Ocular Hypotony And Choroidal Folds Associated With Myotonic Dystrophy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5664.
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The purpose of this study was to determine the effect of topical corticosteroid treatment over 48 months in a patient with unilateral hypotony and choroidal folds associated with myotonic dystrophy.
A 52 y.o pseudophakic patient was seen in our ophthalmology department one month following rapid onset of decreased vision OS. Examination revealed unilateral choroidal folds OS in the context of ocular hypotony with no other associated pathology or risk factors besides a known mutation for Steinert dystrophy DM2. Since he was not known to be glaucomatous nor a steroid responder, he was put on a unilateral treatment of daily topical corticosteroids. The primary outcomes we followed were visual acuity improvement, maintenance of an IOP of >5 mmHg and subjective satisfaction from treatment. Visual acuity improvement was defined as an increase in >2 lines of acuity.
At presentation, the patient had a visual acuity of 20/180 and an IOP of 6mmHg OS. Over the course of treatment with dexamethasone and then fluorometholone 0.1% drops, the patient’s acuity improved to 20/20 OS and the IOP rose from 5-8mmHG to 16 within four months. Initial symptomatic choroidal folds disappeared completely. Two episodes of asymptomatic pressure spikes were noted within the first year after initiating the topical steroid treatment. The ocular hypertension was quickly controlled with anti glaucomatous topical medication and no further recurrence was encountered thereafter. There were no other complications or glaucomatous changes. Four years into continued treatment, visual acuity remained at 20/20, and IOP was 15mmHG OS on last follow-up with absence of visual field defects.
While much effort goes into tension-lowering therapeutics, the restoration of normal IOP remains challenging in cases of hypotony and its associated retinal complications. This report documents the longest follow-up on a patient who underwent long-term topical corticosteroid for a unilateral hypotony most likely related to myotonic dystrophy with total visual function recovery and lasting stabilization of IOP in the mid teens.
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