To report an old patient diagnosed as primary open angel glaucoma (POAG), complicated with irreversible corneal edema after application of topical carbonic anhydrase inhibitor. A 81-year-old man with a previous diagnosis of right and left POAG, of 14-years and 5-years duration respectively, was admitted to our clinic. On ophthalmic examination right eye was absolut glaucoma, and intraocular pressure was measured as 34 mmHg, and visual acuity was 20/200 and intraocular pressure 24 mmHg for the left eye. Gonioscopic examination revealed bilaterally open angles. On anterior segment examination, we observed bilaterally clear cornea, and anterior chamber depths were normal. There was right matur nuclear cataract and left +++ nuclear sclerosis. On fundus examination, there was total right optical atrophy, a left cup/disc ratio of 6/10, and concantric narrowing on left perimetric examination. We considered combined operation, which was refused by the patient. Then treatment with dorzolamide and timolol was started. The patient, who didn’t came periodically for follow-ups, was referred to our clinic 3 months later with blurred vision of the left eye. The left eye examination revealed vision had dropped counting fingers at 2-3 m, and we observed difffuse stromal edema on the central cornea. The drugs were changed with topical prednisone 4 drops/day. On pacimetric examination, the corneal thickness was 0.53 mm for the right eye, and 0.59 mm for the left eye. On later follow-ups, corneal edema did not disappear.

We consider that topical carbonic anhidraz inhibitors should carefully be selected in old patients under risk of corneal endothelial decompensation. ©2008, Firat University, Medical Faculty