Sir,

We report a patient with Sturge–Weber syndrome-associated diffuse choroidal haemangioma who developed serous retinal detachment shortly after starting topical bimatoprost. Cessation of bimatoprost led to complete resolution of the subretinal fluid. This adverse effect of bimatoprost has not been previously reported.

Case report

A 16-year-old girl with Sturge–Weber syndrome-associated bilateral diffuse choroidal haemangiomas was referred with a 6-month history of blurred vision in her left eye. She had been treated for ocular hypertension for 11 years and was using timolol/dorzolamide (Cosopt), brimonidine, and bimatoprost for both eyes.

The blurred vision began shortly after switching from latanaprost to bimatoprost in both eyes. Visual acuities were 6/5 in the right and 6/9 in the left eye. Bilateral diffuse choroidal haemangiomas were confirmed on angiography (fluoroscein and indocyanaine green) and ultrasound. OCT confirmed the presence of significant subretinal fluid inferiorly, which extended to the left fovea, where the changes looked chronic and there was fibrinous deposit (Figures 1a and b).

Figure 1
figure 1

OCTs of the left eye showing fovea on presentation (a), inferior retina on presentation (b), fovea 6 weeks after stopping bimatoprost (c), inferior retina 6 weeks after stopping bimatoprost (d).

Full size image

An adverse effect of bimatoprost was suspected due to its recent introduction and the fact that a similar case related to travoprost had previously been reported.1 Bimatoprost was therefore stopped and the patient was reviewed 6 weeks later, during which time she noticed subjective visual improvement. Visual acuity had improved to 6/5 in either eye and OCT confirmed complete resolution of the subretinal fluid (Figures 1c and d).

Visual acuity has remained 6/5 in either eye with no subretinal fluid through 1 year of follow-up. Intraocular pressures are controlled on g.Cosopt tds, g.Apraclonidine 0.5% tds, and g.Pilocarpine 2% tds to both eyes.

Comment

Sturge–Weber syndrome is a sporadic neurocutaneous disorder characterised by facial capillary malformation (port-wine stain), leptomeningeal angioma, and vascular ocular abnormalities.2 The ocular manifestations consist of glaucoma in 71%, conjunctival or episcleral haemangiomas in 69%, and diffuse choroidal haemangiomas in 55% of patients.3 There has been one report of a patient with Sturge–Weber syndrome who developed uveal effusion shortly after starting topical travoprost, which resolved approximately 3 weeks after stopping the travaprost.1 Our case report suggests that bimatoprost, as well as travoprost, should be used with caution in eyes with Sturge–Weber syndrome-associated diffuse choroidal haemangioma.