Retinal vascular changes after sudden intraocular pressure reduction.

A 33-year-old man, diagnosed with angle recession glaucoma in the left eye, had intraocular pressure (IOP) of 54 mmHg. Fundus examination showed dilated, engorged, and tortuous retinal vessels, average size disc, 0.6: 1 cup disc ratio (CDR) and thinning of superior and inferior neuroretinal rim (NRR) [Fig. 1a] He underwent trabeculectomy augmented with Mitomycin C. Two weeks later, IOP was 10 mmHg, a decrease in the caliber and tortuosity of the major retinal vessels was noted, optic disc showed diffuse a pallor, 0.4:1 CDR, coiled, large collateral vessels on the supero-nasal NRR (white arrow), fine capillaries tuft on the inferior NRR (blue arrow), and fine collaterals on the inner border of temporal NRR (black arrow) [Fig. 1b].

Figure 1

(a) Fundus photograph of the left eye shows dilated and tortuous retinal vessels, 0.6:1 cup disc ratio and thin superior and inferior neuroretinal rim (NRR). (b) Fundus photo of the left eye shows a decrease in the major retinal vessels tortuosity. Optic disc shows diffuse pallor, 0.4: 1 CDR, coiled collateral vessels on the supero-nasal neuroretinal rim (white arrow), fine collaterals (blue arrow), and tuft of capillaries on the border of temporal NRR

Disc collaterals or retino choroidal collaterals at the optic disc are found in ocular conditions such as central retinal vein occlusion or glaucoma.[12] In this patient, IOP reduction caused gradual reversal of the venous stasis, as seen clinically by a decrease in the venous tortuosity and caliber. This interesting finding of newly formed disc collaterals, which became visible at 2 weeks after trabeculectomy, can possibly be explained by gradual and slow development of collaterals, probably a few months after the onset of venous stasis, which was secondary to the high IOP.[3]

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