Uveitis-induced Refractory Ocular Hypotony Managed with High-dose Latanoprost

Abstract

Purpose: To report a case of refractory ocular hypotony due to chronic Behcet’s disease with good response to high-dose topical latanoprost.


Case Report: We present a 26-year-old man with a known history of Behcet’s disease who developed decreasing vision and severe ocular hypotony that was refractory to multiple treatment modalities including subtenon triamcinolone acetonide, ibopamine, pars plana vitrectomy, and silicone oil injection. We decided to try high-dose topical latanoprost for the management of ocular hypotony based on recent reports. After six months, intraocular pressure (IOP) increased by 5 mm Hg, became stable at 7 mm Hg, and remained unchanged at month 24.


Conclusion: High-dose topical latanoprost could lead to significant increase in IOP in uveitis-induced refractory ocular hypotony.

Keywords:

Behcet, Hypotony, Inflammation, Latanoprost, Uveitis

References
1. de Smet MD, Gunning F, Feenstra R. The surgical management of chronic hypotony due to uveitis. Eye 2005;19:60–64.

2. Tran VT, Mermoud A, Herbort CP. Appraisal and management of ocular hypotony and glaucoma associate with uveitis. Int Ophthalmol Clin 2000;40:175–203.

3. Kapur R, Birnbaum AD, Goldstein DA, Tessler HH, Shapiro MJ, Ulanski LJ, et al. Treating uveitis-associated hypotony with pars plana vitrectomy and silicone oil injection. Retina 2010;30:140–145.

4. Pederson JE. Hypotony. In: Tasman W, Jaeger, EA, editors. Duane’s clinical ophthalmology. Philadelphia, PA: Lippincott-Raven; 1999; 1–8.

5. Ugahary Le, Ganteris E, Veckeneer M, Cohen AC, Jansen J, Mulder PG, et al. Topical ibopamine in the treatment of chronic ocular hypotony attributable to vitreoretinal surgery, uveitis, or penetrating trauma. Am J Ophthalmol 2006;141:571–573.

6. Sen HN, Drye LT, Goldstein DA, Larson TA, Merrill PT, Pavan PR, et al. Hypotony in patients with uveitis: the Multicenter Uveitis Steroid Treatment (MUST) trial. Ocul Immunol Inflamm 2012;20:104–112.

7. Pederson JE, Mac Lellan HM. Medical therapy for experimental hypotony. Arch Ophthalmol 1982;100:815–817.

8. Lim KS, Nau CB, O’Byrne MM, Hodge DO, Toris CB, McLaren JW, et al. Mechanism of action of bimatoprost, latanoprost, and travoprost in healthy subjects. A crossover study. Ophthalmology 2008;115:790–795e794.

9. Abdel-Latif AA. Release and effects of prostaglandins in ocular tissues. Prostaglandins Leukot Essent Fatty Acids 1991;44:71–82.

10. Sacca S, Pascotto A, Siniscalchi C. Ocular complications of latanoprost in uveitic glaucoma: three case reports. J Ocul Pharmacol Ther 2001;17:107–113.

11. Chang JH, McCluskey P, Missotten T, Ferrante P, Jalaludin B, Lightman S. Use of ocular hypotensive prostaglandin analogues in patients with uveitis: does their use increase anterior uveitis and cystoid macular oedema? Br J Ophthalmol 2008;92:916–921.

12. Markomichelakis NN, Kostakou A, Halkiadakis I, Chalkidou S, Papakonstantinou D, Georgopoulos G. Efficacy and safety of latanoprost in eyes with uveitic glaucoma. Graefes Arch Clin Exp Ophthalmol 2009;247:775–780.