Winning the battle of refractory hypotony

Trabeculectomy, a mainstay in the management of glaucoma is associated with various complications, the most dreaded being hypotony.

We present a challenging case of late-onset refractory hypotony following trabeculectomy.

: A 64-year-old male patient diagnosed with primary open angle glaucoma in the right eye underwent combined surgery. Three weeks later, he presented with hypotony which responded well with medical management and then he was lost to follow-up. Two years later, he presented with severe hypotony with shallow choroidal detachment in the right eye, which failed to respond to medical management. Compression sutures were placed over the bleb which also failed to work. Subsequently bleb repair was done with corneal patch graft, which helped resolve the bleb leak, with an improvement in visual acuity and intraocular pressure.

This video highlights the importance of prompt and timely intervention of an overfiltering bleb in preventing irreversible visual loss.

https://youtu.be/8DrxzqQ4qP4.