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Abstract #90830 Published in IGR 21-3

Persistent Hypotony and Annular Ciliochoroidal Detachment After Microhook Ab Interno Trabeculotomy

Ishida A; Mochiji M; Manabe K; Matsuoka Y; Tanito M
Journal of Glaucoma 2020; 29: 807-812

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: PRéCIS: Creation of a cyclodialysis cleft can be a mechanism of ciliochoroidal detachment (CCD) and associated persistent hypotony after microhook ab interno trabeculotomy (μLOT). AIMS: To report persistent hypotony after μLOT, a minimally invasive glaucoma surgery (MIGS). SUBJECTS AND METHODS: This observational case series included 4 consecutive cases (3 men, 1 woman; mean age, 48.8±15.1 y) of persistent hypotony that developed after μLOT between May 2015 and March 2018. The patients' data and surgical results were obtained from the medical charts. RESULTS: All patients had open-angle glaucoma (2 juvenile, 1 primary, and 1 pigmentary) and were myopic (axial lengths, >24 mm). Two patients had undergone previous refractive surgery. μLOT alone was performed in 2 cases and combined with cataract surgery in 2 cases. In all cases, hypotony below 5 mm Hg was recorded 1 day postoperatively and sustained. In all cases, ultrasound biomicroscopy showed an annular CCD; communication between the anterior chamber and suprachoroidal space was detected in 3 of 4 cases. The hypotony resolved in 3 of the 4 cases from 2 to 8 months postoperatively, that is, spontaneously in 2 cases (cases 1 and 4) and after sulfur hexafluoride gas injection into the anterior chamber in 1 case (case 2). CCD resolution accompanied remarkedly high intraocular pressure, which required filtration surgeries. The incidence of persistent hypotony was 0.7% (4/547 eyes). CONCLUSIONS: After MIGS, persistent hypotony because of CCD rarely occurs. Increased uveoscleral outflow because of LOT or creation of a cyclodialysis cleft by traction of the pectinate ligament can be a mechanism of CCD development. Young age and myopia can be risks for cyclodialysis cleft formation and hypotony maculopathy after MIGS.

Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Shimane.

Full article

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Classification:

12.9 Trabeculotomy, goniotomy (Part of: 12 Surgical treatment)
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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