Kissing Choroidals Despite Normal Intraocular Pressure Following Ahmed Clear Path Implantation in a Vitrectomized Eye

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Ocular Imaging

Background:

• Choroidal effusion is a known complication of glaucoma drainage devices, typically linked to hypotony.
• The Ahmed Clear Path (ACP) implant is designed to mitigate these risks.
• Eyes with altered anatomy, such as post-vitrectomy, may still experience atypical outcomes.

Purpose of the Study:

• To report the first case of "kissing" serous choroidals after ACP implantation in a vitrectomized eye.
• To investigate the occurrence of choroidal effusion despite normal intraocular pressure (IOP).

Main Methods:

• Case report of a 68-year-old monocular man with prior vitrectomy.
• Ahmed Clear Path (ACP) implantation was performed.
• Postoperative assessment included IOP measurement and bright-scan ultrasound (B-scan).

Main Results:

• The patient developed sudden visual deterioration on postoperative day 3.
• Bright-scan ultrasound confirmed "kissing" choroidals despite stable IOP (10 mmHg).
• Conservative management with corticosteroids and cycloplegics led to complete anatomical and functional recovery by postoperative day 60.

Conclusions:

• Serous choroidals can occur without hypotony in eyes with altered structural dynamics, like post-vitrectomy globes.
• The ACP implant's design may not fully counteract such anatomical predispositions.
• Conservative management is a viable option for selected cases with maintained IOP, and posterior segment pressurization may prevent early effusions in high-risk eyes.