Serous retinal detachment with retinal pigment epithelium tear after PreserFlo MicroShunt surgery: a case report

The PreserFlo MicroShunt is a minimally invasive glaucoma drainage device designed to lower intraocular pressure (IOP) with fewer complications compared with those of traditional filtration surgery. Hypotony and choroidal detachment (CD) are known postoperative risks. However, retinal pigment epithelium (RPE) tears and serous retinal detachment following PreserFlo MicroShunt have not been reported previously. We report a case of retinal detachment with an RPE tear under hypotony following minimally invasive glaucoma surgery using a drainage device that required surgical intervention to elevate the IOP and achieve resolution.

A 53-year-old man with a history of ocular hypertension and cataract surgery with intraocular lens suturing developed uncontrolled IOP in his right eye. PreserFlo MicroShunt surgery was performed but resulted in hypotony and subsequent CD. Despite initial management with atropine eye drops and oral steroids, retinal detachment with RPE tears developed. Scleral drainage and pars plana vitrectomy with sulfur hexafluoride (SF6) gas tamponade were performed to elevate IOP and stabilize the retinal condition, leading to the successful resolution of the detachment. Postoperatively, the IOP stabilized within the mid-teens without observing recurrence.

This is the first reported case of RPE tears and serous retinal detachment following Preserflo MicroShunt surgery. These findings highlight that a rapid and significant reduction in IOP, even without reaching absolute hypotony, might disrupt choroidal circulation and RPE integrity, particularly in eyes with predisposing factors, such as atopic dermatitis and long-term steroid use. Early recognition of CD and timely intervention to elevate IOP are crucial for preventing vision-threatening complications.