[Massive choroidal detachment secondary to topical use of bimatoprost: Report of two cases]

To report two cases of choroidal detachment induced by topical bimatoprost.

Two males, aged 95 (case 1) and 74 years (case 2), were referred to our department for massive choroidal detachment. Case 1 was a one-eyed patient, and the affected eye of case 2 had undergone trabeculectomy 2 years previously. Both affected eyes were pseudophakic and treated for 6 months with topical bimatoprost/timolol fixed combination for open angle glaucoma (case 1) and pseudoexfoliation glaucoma (case 2). In both cases, symptoms appeared immediately after starting the drops and progressively worsened thereafter. In both affected eyes, moderate conjunctival hyperemia was noted, anterior segment examination and intraocular pressure were normal, and fundus examination revealed a massive choroidal detachment. This diagnosis was confirmed by B-scan ultrasonography. An adverse effect of bimatoprost was suspected, and the drug was discontinued, leading to the complete resolution of the choroidal detachment within 3 weeks in both eyes.

Choroidal detachment is a rare adverse effect which is not specific to bimatoprost but which has been also reported with the other prostaglandin analog drops. Its exact cause remains unclear, but is probably linked to the combination of enhanced uveoscleral outflow and pro-inflammatory properties. In all cases, the discontinuation of the prostaglandin analog led to the complete resolution of the choroidal detachment within 3 weeks.