A 21-year-old Japanese man was referred to our institute in June 2002 because of uncontrollably elevated IOP in his right eye after repeated surgical procedures (phacoemulsification, scleral encircling, pars plana vitrectomy, and trabeculectomy) for cataract and rhegmatogenous retinal detachment associated with atopic dermatitis. He had no history or family history of collagenous diseases. At initial examination, his best-corrected visual acuity was 20/200. His IOP was 47 mm Hg as measured with Goldmann applanation tonometry, despite maximally tolerant medical therapy, normal depth of the anterior chamber, open angle, artificial aphakia, a cup-disc ratio of 0.9, and a mean deviation of −19.26 dB on a Humphrey 30-2 program in the right eye. The left eye was normal. Following trabeculectomy with the adjunctive use of mitomycin C, 0.04%, a month later, the IOP fluctuated between 5 and 48 mm Hg owing to filtration blockage and its subsequent release by laser suture lysis and a needling procedure until August 2003, when diode laser cyclodestruction was eventually performed. Although no apparent visual field defect progression or central corneal thickness fluctuation (mean [SD], 532  μm) occurred during this period, enlarging and reduction of cupping correlated with the IOP fluctuation, which accompanied asymmetrical extension and reduction of the disc size (Figure). Therefore, the higher IOP corresponded to a larger disc diameter with more prominent horizontal expansion.