Retinal Pigment Epithelial Tear and Retinal Detachment Following Hypotony After Trabeculectomy: A Case Report

Hypotony after trabeculectomy (TLE) can lead to choroidal detachment (CD) and maculopathy. We present a case of retinal detachment caused by extensive retinal pigment epithelial (RPE) tears following hypotony following TLE surgery. A 67-year-old man underwent TLE in the left eye for open-angle glaucoma. Postoperatively, intraocular pressure (IOP) remained stable at approximately 10 mmHg. However, after 50 days, the IOP decreased due to aqueous humor leakage, which required several conjunctival sutures. CD occurred on day 87. On day 108, retinal detachment was detected in the inferior retina of the left eye, and vitrectomy was performed for suspected rhegmatogenous retinal detachment. During surgery, no retinal tears were observed; however, an RPE tear spanning 120° from the 1 o'clock to 5 o'clock position involving the temporal midperiphery to the periphery was observed. The detached RPE was adherent to the underside of the detached retina. Fluid-gas exchange was performed, and subretinal fluid was aspirated from the intentional tears. The next day, IOP was 16 mmHg, and retinal detachment showed improvement. However, by day 5, hypotony recurred due to aqueous leakage, reducing the IOP to 5 mmHg and resulting in redetachment. This required surgical closure of the TLE scleral flap. The following day, IOP increased to 27 mmHg, and the retinal detachment resolved. At the 3-month follow-up, IOP was 16-19 mmHg with medication, and no recurrence of retinal detachment was noted. Serous retinal detachment may result from RPE tears caused by prolonged hypotony following TLE. Prompt and appropriate management of the IOP may improve retinal detachment and prevent its recurrence.