Ocular decompression retinopathy following post-trabeculectomy suture lysis and management with triamcinolone acetonide

Ocular decompression retinopathy (ODR) is a rare complication of sudden lowering of intraocular pressure (IOP) in glaucoma and ocular hypertension. An 80-year-male, a known case of chronic open-angle glaucoma for 13 years, had his IOP controlled by multiple topical antiglaucoma medications. There was an increase in IOP, progression of optic disc cupping and visual field loss along with cataract over the past 6 months. The patient underwent uneventful phacoemulsification with posterior chamber intraocular lens (PCIOL) and penetrating trabeculectomy. Postoperatively, the trabeculectomy bleb was flat and IOP was 44 mmHg and was not controlled by bleb massage. Bleb needling and suture lysis were performed after 2 weeks. The IOP dropped from 44 to 6 mmHg. Three days later the patient presented with a sudden decline in visual acuity (VA) from 0.5 to 1.225 logMAR. The fundus showed multiple retinal haemorrhages resembling ODR. Choroidal detachment also occurred after 3 weeks. Optical coherence tomography confirmed the presence of macular oedema which was treated with an orbital floor triamcinolone acetonide injection (OFTA). The haemorrhages, choroidal detachment and macular oedema resolved and VA improved in 6 months. This is the first case report of ODR following suture lysis and needling after an uneventful combined phacoemulsification with PCIOL implant and trabeculectomy. It also highlights the role of OFTA injections in the management of ODR.