Manchester Royal Eye Hospital, Manchester, United Kingdom.
J Glaucoma. 2019 Mar;28(3):e41-e43. doi: 10.1097/IJG.0000000000001140.
Low intraocular pressure and hypotony secondary to overfiltration is a recognized complication after trabeculectomy, particularly when augmented with antimetabolites such as 5-fluorouracil and mitomycin C. The relatively recent introduction of minimally invasive glaucoma surgery such as the ab interno XEN 45 (Allergan, Ireland) subconjunctival gel implant has heralded a new era of glaucoma drainage surgery where postoperative complications may be less and surgical recovery quicker. However, any effective glaucoma filtering procedure will always carry the risk of inducing hypotony. We describe the case of an 84-year-old white gentleman who underwent right eye XEN implantation for refractory primary open-angle glaucoma who subsequently developed persistent hypotony secondary to an overfiltering bleb. The complication was successfully treated with a modified transconjunctival bleb compression suture technique. To our knowledge, this has not been previously described in the literature and may help the glaucoma specialist deal effectively and relatively noninvasively with this rare but potentially challenging minimally invasive glaucoma surgery complication.
低眼内压和滤过过强导致的低眼压是小梁切除术的一种公认的并发症，尤其是在使用 5-氟尿嘧啶和丝裂霉素 C 等代谢抑制剂增强时。微创青光眼手术（如 ab interno XEN 45（Allergan，爱尔兰）结膜下凝胶植入物）的引入相对较新，标志着青光眼引流手术的新时代的到来，术后并发症可能更少，手术恢复更快。然而，任何有效的青光眼滤过手术都始终存在引发低眼压的风险。我们描述了一位 84 岁的白人男性的病例，他因难治性原发性开角型青光眼接受了右眼 XEN 植入术，随后因滤过过强的滤泡而出现持续性低眼压。该并发症通过改良的经结膜滤泡压迫缝线技术成功治疗。据我们所知，这在文献中尚未有过描述，可能有助于青光眼专家有效地、相对非侵入性地处理这种罕见但具有潜在挑战性的微创青光眼手术并发症。
