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Letter to the Editor
Visual loss after primary trabeculectomy with mitomycin C in Ehlers-Danlos syndrome
  1. M FRANCESCA CORDEIRO
  1. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  2. Moorfields Eye Hospital and National Hospital for Neurology and Neurosurgery, London
  3. St George’s Hospital Medical School, London
  4. Moorfields Eye Hospital, London
  5. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  1. GORDON T PLANT
  1. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  2. Moorfields Eye Hospital and National Hospital for Neurology and Neurosurgery, London
  3. St George’s Hospital Medical School, London
  4. Moorfields Eye Hospital, London
  5. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  1. ANNE CHILD
  1. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  2. Moorfields Eye Hospital and National Hospital for Neurology and Neurosurgery, London
  3. St George’s Hospital Medical School, London
  4. Moorfields Eye Hospital, London
  5. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  1. BARRY JONES
  1. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  2. Moorfields Eye Hospital and National Hospital for Neurology and Neurosurgery, London
  3. St George’s Hospital Medical School, London
  4. Moorfields Eye Hospital, London
  5. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  1. PENG T KHAW
  1. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  2. Moorfields Eye Hospital and National Hospital for Neurology and Neurosurgery, London
  3. St George’s Hospital Medical School, London
  4. Moorfields Eye Hospital, London
  5. Wound Healing Research and Glaucoma Units, Institute of Ophthalmology and Moorfields Eye Hospital, London
  1. Peng T Khaw, Wound Healing Group and Glaucoma Unit, Pathology Department, Institute of Ophthalmology, Bath Street, London EC1V 9EL.

https://doi.org/10.1136/bjo.83.10.i1194

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    Editor,—Antiproliferatives such as mitomycin C are commonly used in glaucoma filtration surgery in patients at high risk of scarring postoperatively. Although ocular hypotony and maculopathy are known complications of such surgery, reversible and profound vision loss in association with hypotony induced optic disc swelling is rare. It has previously been suggested that hypotony related complications may be more common in myopes as they have reduced scleral rigidity. We present a case of ocular hypotony following mitomycin C assisted trabeculectomy with severe vision loss associated with disc swelling. We feel it highlights the dangers of antimetabolite use in patients with connective tissue disorders where there are inherent problems in wound healing and scleral rigidity. To our knowledge this is the first report of post filtration hypotony and reversible vision loss occurring as a complication of adjuvant therapy in a case of Ehlers-Danlos syndrome with reduced scleral rigidity.

    CASE REPORT

    A 12 year old girl was referred to Moorfields Eye Hospital for a second opinion regarding her deteriorating vision following bilateral trabeculectomies with adjuvant mitomycin C for raised intraocular pressure.

    At the age of 5 years, she was diagnosed as having megalocornea with ocular hypertension. Two years later, because of the persistent degree of IOP elevation (between 30–40 mm Hg), she was commenced on bilateral medical treatment. However, at the age of 11, she developed such severe problems with her topical treatment that surgery was considered necessary. In May 1996 right and subsequently left trabeculectomies were performed and during the procedures subconjunctival mitomycin C (0.3 mg/ml) was applied for 5 minutes. Her postoperative recovery was complicated by the development of ocular hypotony.

    She was seen at Moorfields for the first time with progressive bilateral vision loss and recent onset of transient obscurations, 5 months after her filtration surgery and the onset of …

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