The following is a summary of “Ab Externo Choroidal Fluid Drainage, Pars Plana Vitrectomy, and Endotamponade for the Management of Persistent Hypotony following Glaucoma Surgery,” published in the July 2024 issue of Ophthalmology by Koenig et al.

Persistent severe serous choroidal detachment is an uncommon complication following glaucoma surgery and may benefit from combining choroidal fluid drainage (CFD) with pars plana vitrectomy (PPV) and gas endotamponade.

Researchers conducted a retrospective study presenting the perioperative outcomes of combining CFD with PPV and gas endotamponade in patients with persistent severe serous choroidal detachment after glaucoma surgery.

They analyzed outcomes of ab externo drainage combined with PPV and gas endotamponade for persistent serous choroidal detachment (≥4 weeks) in 6 eyes of 6 patients who had not responded to conservative treatments. The inclusion criterion was persistent hypotony (PH)  with severe serous choroidal detachment following intraocular pressure (IOP) lowering surgery for medically uncontrolled glaucoma. Evaluations focused on choroidal detachment resolution, changes in IOP and visual acuity (VA), post-drainage complications, and the necessity for additional surgeries.

The result showed that all the patients had a flat anterior chamber, diminished vision, and persistent choroidal detachment. Although the surgical procedures proceeded without complications, individual adjustments were necessary due to the complexity of each case. By 1 month, choroidal effusion resolved completely in 5 eyes and 1 eye by 3 months. Average IOP increased from 5 (±2.1) mmHg before surgery to 11.3 (±3.7) mmHg, and VA improved from 1.7 (±0.8) to 1.2 (±0.6) logMAR. Despite the resolution of choroidal detachment, 5 of the 6 patients required additional surgery, primarily to further elevate the IOP.

Investigators concluded that ab externo CFD combined with PPV and gas endotamponade was a promising and safe approach for persistent ocular hypotony, though larger prospective studies were needed to confirm the findings.

Source: https://onlinelibrary.wiley.com/doi/full/10.1155/2024/5323632