Ocular Decompression Retinopathy Followed by Central Retinal Vein Occlusion After Augmented Trabeculectomy in Pseudoexfoliative Glaucoma: A Case Report.

We report a rare sequential presentation of ocular decompressive retinopathy (ODR) and central retinal vein occlusion (CRVO) following trabeculectomy in a patient with pseudoexfoliative glaucoma (PXG). A 62-year-old woman with poorly controlled hypertension, bilateral grade II hypertensive retinopathy, and left-eye PXG initially achieved intraocular pressure (IOP) control with maximal medical therapy but was lost to follow-up. She re-presented with an IOP of 65 mmHg in the left eye and progressive glaucomatous damage despite maximal topical and systemic agents, necessitating augmented trabeculectomy with mitomycin C. Postoperatively, she developed hypotony (IOP: 5 mmHg) with fundus findings of ocular decompression retinopathy. Six weeks later, vision declined from 6/18 to 2/60 with new dilated tortuous veins, worsening hemorrhages, and cystoid macular edema (CME) confirmed on optical coherence tomography (OCT) (central subfield thickness (CST): 1100 µm). Fundus fluorescein angiography (FFA) showed delayed arteriovenous (AV) transit without capillary nonperfusion, consistent with nonischemic CRVO. She received three monthly intravitreal ranibizumab injections, resulting in the best-corrected visual acuity (BCVA) improvement of 6/24, marked CME resolution (389 µm), and stable IOP in the low teens. This case highlights that CRVO may occur after ODR-like postoperative retinal hemorrhages in high-risk patients after trabeculectomy, emphasizing the need for vigilant postoperative surveillance and prompt intervention to preserve vision.