Steroid-induced ocular hypertension in the presence of a functioning Molteno seton

Steroid-induced ocular hypertension is generally attributed to alterations in the trabecular meshwork, reducing aqueous outflow.

A case with several episodes of steroid-induced ocular hypertension is presented. Later, with unremitting intraocular pressures above 50 mmHg, despite maximal hypotensive medication, there is evidence of extensive failure of aqueous egress. A successful Molteno seton bypasses the failed trabecular meshwork to lower the pressure into the teens. The eye is then challenged with topical steroid on two occasions. The pressure rises, only to fall again with steroid withdrawal.

Here is a case where the trabecular meshwork has been bypassed, but ocular hypertension was still induced with the application of topical steroid.