Persistent Serous Choroidal and Retinal Detachment After Ab Interno Trabeculotomy for Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Retinal Diseases

Background:

• Minimally invasive glaucoma surgery (MIGS) is increasingly used for primary open-angle glaucoma.
• Complications such as serous retinal detachment (SRD) and ciliochoroidal detachment (CCD) can occur post-MIGS.
• The long-term sequelae of persistent SRD and CCD after MIGS require further investigation.

Purpose of the Study:

• To report a unique case of prolonged serous retinal detachment (SRD) and ciliochoroidal detachment (CCD) following minimally invasive glaucoma surgery (MIGS).
• To analyze the potential mechanisms and contributing factors to the persistent SRD and CCD.
• To describe the eventual resolution and long-term outcome of this rare complication.

Main Methods:

• A case report of a 71-year-old female patient with primary open-angle glaucoma.
• Detailed description of the patient's surgical procedure: phacoemulsification, intraocular lens implantation, goniosynechialysis, and microhook ab interno trabeculotomy.
• Longitudinal follow-up including best-corrected visual acuity, intraocular pressure measurements, and B-scan ultrasonography to monitor SRD, CCD, and choroidal thickness.

Main Results:

• The patient developed persistent SRD and CCD in the right eye for over 2 years and 7 months post-MIGS.
• Associated findings included increased choroidal thickness, choroidal vessel dilation, and choroidal vascular hyperpermeability.
• Following an IOP spike, the CCD resolved, leading to the disappearance of SRD and choroidal folds, with stable visual acuity and controlled IOP at long-term follow-up.

Conclusions:

• Prolonged ciliochoroidal detachment (CCD) and subsequent low intraocular pressure (IOP) after MIGS may lead to serous retinal detachment (SRD) due to retinal pigment epithelium dysfunction and increased choroidal permeability.
• The limited size of the cyclodialysis cleft created by MIGS might influence aqueous humor dynamics, contributing to the prolonged disease course.
• This case highlights a rare but significant complication of MIGS, emphasizing the importance of monitoring for persistent SRD/CCD and understanding the underlying pathophysiology.