An iris coloboma preventing pigmentary glaucoma.

choice to try a new potent medication once a day instead of his current 2 medications, the patient elected to try travoprost once daily beginning on January 3. Two days later, he called complaining of mild redness, discomfort, andblurriness.Hewasadvised of an adjustment period with this eyedrop and told to call back if symptoms did not improve. His symptoms worsened, and by January 8, his visual acuity had dropped to 20/100 OD. Slitlamp examination findings included 2+ conjunctival hyperemia, 2+ central corneal edema, and diffuse corneal folds in both eyes. There was 1-2+ “cell and flare” in the anterior chamber in both eyes. The intraocular pressure was 11 mm Hg OD and 13 mm Hg OS. Treatment with travoprost was discontinued and lotepredinol etabonate therapy was begun every 6 hours in both eyes. By January 17, the patient’s discomfort resolved and visual acuity had improved to 20/50 OD, the corneal edema was clearing, and the anterior chambers were quiet. Treatment with timolol and brimonidine was restarted, and the loteprednol was tapered and stopped. By February 28 the corneal folds had completely cleared. Central corneal pachymetry measurements on that date were 587 μm OD and 541 μm OS. The endothelial cell count was 661 cells/mm OD and 708 cells/mm OS.