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Recurrent, Delayed-Onset Hyphema Following iStent Inject Managed With Device Removal: A Case Report.

Marybeth K Farazdaghi¹, Lance J Lyons, Gavin W Roddy

¹Department of Ophthalmology, Mayo Clinic, Rochester, MN.

Journal of Glaucoma

|February 17, 2021

Summary

Delayed hyphema after iStent Inject surgery can occur. Surgical removal of the device successfully managed recurrent hyphema in a case study, suggesting collector channel placement may be a factor.

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Area of Science:

Ophthalmology
Glaucoma Surgery
Medical Device Research

Background:

Minimally invasive glaucoma surgeries (MIGS) are gaining popularity for mild to moderate glaucoma.
The iStent Inject trabecular micro-bypass device is a MIGS option used during cataract surgery.
Delayed-onset, recurrent hyphema post-iStent Inject placement is not well-documented.

Observation:

A case of recurrent hyphema after iStent Inject implantation is presented.
Intraoperative observation revealed heme reflux into the anterior chamber upon lowering intraocular pressure.
This reflux originated from the stent's placement site.

Findings:

The recurrent hyphema was successfully managed by surgical removal of the iStent Inject device.
Hypothesis: Collector channel placement may lead to heme influx when intraocular pressure falls below episcleral venous pressure.

Implications:

This case highlights a potential complication of iStent Inject surgery.
Understanding the etiology of delayed hyphema is crucial for patient management.
Further investigation into device placement and its relation to hyphema is warranted.