Micropulse transscleral cyclophotocoagulation in the treatment of autosomal recessive bestrophinopathy combined with angle closure glaucoma: a case report.

Background: Autosomal recessive bestrophinopathy (ARB) comprises remarkable retinal dystrophy characterized by yellowish subretinal lesions scattered in the posterior pole and is always accompanied with refractory angle-closure glaucoma (ACG). The treatment of ACG patients with ARB is a major challenge for all ophthalmologists.

Case Presentation: A 12-year-old female child was diagnosed with ARB and ACG and presented with discrete, round, yellow-white deposits of variable sizes scattered in the retina, retinoschisis in the macular, shallow anterior chamber depth and angle closure with uncontrolled intraocular pressure (IOP). Micropulse transscleral cyclophotocoagulation (MP-TCP) successfully deepened anterior chamber, lowered IOP and resolved retinoschisis. However, the postoperative deepening of the anterior chamber began to regress 12 days after surgery and stabilized 142 days after surgery, the retinoschisis reoccurred 67 days after surgery.

Conclusion: This case revealed that changes in vitreous condition may play an important role in the formation of retinoschisis. MP-TCP, which induces vitreous compression and increases osmotic pressure on the retina, could be used to treat young ACG patients with ARB to avoid other complicated surgeries and vision-threatening postoperative complications. However, the theory needs to be confirmed by further studies.