To report the multimodal imaging characteristics and successful non-surgical intraocular pressure (IOP) control with bimatoprost in a 7-year-old boy with Sturge-Weber syndrome (SWS)-related glaucoma and diffuse choroidal hemangioma (DCH). Case report with multimodal imaging including ultra-widefield fluorescein angiography, indocyanine green angiography, B-scan ultrasound, ultrasound biomicroscopy (UBM), and cranial MRI. A 7-year-old boy with facial port-wine stain (V1 distribution) presented with right ocular distension and IOP of 36 mmHg. Multimodal imaging confirmed DCH, exudative retinal detachment, and open angle. Initial triple therapy (brinzolamide, brimonidine, carteolol) failed to lower IOP. After switching to bimatoprost monotherapy (once daily), IOP decreased to 18 mmHg within 4 weeks and remained stable at 3-month follow-up. No surgical intervention was required. In selected pediatric SWS patients with refractory glaucoma, bimatoprost may achieve excellent IOP control, avoiding surgical risks. Multimodal imaging is essential for accurate diagnosis and monitoring. This case challenges the traditional view that topical medications are ineffective in SWS-related glaucoma and highlights the potential of prostaglandin analogs as a first-line or early adjunctive therapy.
Tianyi et al. (Sat,) studied this question.