Management of Persistent Hypotony after Supraciliary CyPass^® Implantation Using Argon Laser

To report a case and management of persistent hypotony with hypotony-induced maculopathy after CyPass^® device implant.

The CyPass^® was the first supraciliary ab interno device approved by FDA and commercially available. Efficacy studies showed adequate intraocular pressure (IOP)-lowering results in combination with phacoemulsification. Hypotony induced by suprachoroidal minimally invasive glaucoma surgery (MIGS) was reported to be lower than 3% in the population that comprised the COMPASS study.

A 57-year-old female patient with mild open-angle glaucoma with maximum topical medical therapy who underwent sequential bilateral CyPass^® implantation developed persistent hypotony. Device obstruction was induced through argon laser burns directed to the peripheral iris, and the device was no longer visible on follow-up examinations. Topical IOP-lowering medication was restarted (timolol-dorzolamide) and has since been controlled under 16 mm Hg, without progression on visual fields.

Argon laser burns directed to the peripheral iris to induce synechiae development that produces device obstruction are an effective technique to manage persistent hypotony after supraciliary CyPass^® implantation.

Here, authors show a novel approach for treatment of persistent hypotony secondary to CyPass^® implantation. In the knowledge of the authors, this is the first report that describes a noninvasive management for this complication, and this case could help other physicians to manage similar cases.

Fernando DV-N, Díez-Cattini GF, Alfonso G-L, et al. Management of Persistent Hypotony after Supraciliary CyPass^® Implantation Using Argon Laser. J Curr Glaucoma Pract 2019;13(3):116-118.