Successful trabeculotomy in a patient with corticosteroid-induced glaucoma with anti-aquaporin 4 antibody-positive neuromyelitis optica: a case report

Corticosteroid therapy is a first-choice treatment for anti-aquaporin 4 antibody-positive neuromyelitis optica. Although we expected corticosteroid-induced glaucoma as a potential complication of the therapy, there are no reports in the literature describing it. In this report, we describe a case of successful trabeculotomy performed on a patient with corticosteroid-induced glaucoma and anti-aquaporin 4 antibody-positive neuromyelitis optica.

A 40-year-old Japanese woman who was given prednisolone orally after the diagnosis of anti-aquaporin 4 antibody-positive neuromyelitis optica experienced acute, painful loss of vision in her right eye. Although her right eye intra-ocular pressure was increased, we considered the main cause of her recent visual disturbance to be neuromyelitis optica because her right eye visual acuity declined to no light perception within a short period with a marked central scotoma. We treated our patient with high-dose methylprednisolone and double-filtration plasmapheresis; however, no improvement was observed. After we performed trabeculotomy in her right eye, our patient’s post-operative intra-ocular pressure was maintained within the normal range. Her visual acuity drastically improved soon after the decrease of intra-ocular pressure.

Both neuromyelitis optica and glaucoma caused our patient’s visual disturbance, and clinicians should plan for treatment of both neuromyelitis optica and glaucoma in such cases.