lupus flare in a manifestation of consecutive hypotony maculopathy after trabeculectomy

Systemic lupus erythematosus (SLE) up-raises the surgical risk due to its unpredictable perioperative disease activity. Lupus flare represents an important issue because of its potential threat in organ damage and drug toxicity after adjusting the dosage of immune-modulating agents. A 34-year-old female was referred for trabeculectomy surgery for her poor-controlled steroid-related glaucoma with a 5-year history of SLE under systemic steroids control. Remission status was confirmed with normal serum complement levels. However, lupus flare with clinical ocular findings as hypotony maculopathy presented 1-week after uneventful surgery. Early and effective treatment with pulse corticosteroid therapy was conducted, and this patient recovered her ocular performance 1-month later except preexisting glaucomatous visual field deficits. SLE flare may be seen in any form of postoperative complications, even masked with consecutive hypotony maculopathy. This case reminds early detection of systemic lupus flare and different therapeutic plan is prompt in postoperative follow-up.