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

BACKGROUND Choroidal effusion is a known complication of glaucoma drainage devices. It is typically associated with hypotony. The Ahmed Clear Path (ACP) implant, a novel valveless glaucoma drainage device with an intraluminal ripcord, is designed to reduce such risks. However, eyes with altered anatomy - such as those previously vitrectomized - may still be prone to atypical postoperative outcomes. We report the first known case of "kissing" serous choroidals following ACP implantation in a vitrectomized eye, despite normal intraocular pressure (IOP). CASE REPORT A 68-year-old monocular man with prior vitrectomy underwent ACP implantation in his only seeing eye. On postoperative day 3, he developed sudden visual deterioration. Despite stable IOP at 10 mmHg and a well-formed anterior chamber without leakage or overfiltration, bright-scan ultrasound (B-scan) confirmed kissing choroidals. The effusion was attributed to reduced posterior segment support and scleral rigidity in the vitrectomized eye. Conservative management with corticosteroids and cycloplegics led to progressive resolution without surgical intervention. No permanent visual deterioration was observed despite persistent kissing choroidals for 9 days. By postoperative day 60, complete anatomical and functional recovery was achieved. CONCLUSIONS This case illustrates that serous choroidals, including kissing choroidals, may occur even in the absence of hypotony, particularly in eyes with altered structural dynamics like post-vitrectomy globes. The ACP's ripcord may be insufficient to counterbalance such anatomical predispositions. Conservative management may be appropriate in select cases, provided IOP is maintained. Surgeons should consider posterior segment pressurization using balanced salt solution during filtration surgery in high-risk eyes to prevent early effusions.