Sadahide Ayako, Harada Yosuke, Sakaguchi Hirokazu, Sadahide Ayako
Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Harada Eye Clinic, Higashi-Hiroshima, Japan.
BMC Ophthalmol. 2025 Jul 24;25(1):424. doi: 10.1186/s12886-025-04259-6.
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.
PreserFlo微型分流器是一种微创青光眼引流装置，旨在降低眼压（IOP），与传统滤过手术相比并发症更少。低眼压和脉络膜脱离（CD）是已知的术后风险。然而，PreserFlo微型分流器术后视网膜色素上皮（RPE）撕裂和浆液性视网膜脱离此前尚未见报道。我们报告一例在使用引流装置的微创青光眼手术后出现低眼压伴RPE撕裂的视网膜脱离病例，该病例需要手术干预以提高眼压并实现病情缓解。
一名53岁男性，有高眼压病史且接受过白内障手术并植入人工晶状体缝线，其右眼眼压控制不佳。进行了PreserFlo微型分流器手术，但导致了低眼压及随后的脉络膜脱离。尽管最初使用阿托品滴眼液和口服类固醇进行治疗，仍发生了伴有RPE撕裂的视网膜脱离。进行了巩膜引流和平坦部玻璃体切除术并使用六氟化硫（SF6）气体填塞以提高眼压并稳定视网膜状况，从而成功缓解了视网膜脱离。术后，眼压稳定在十几mmHg范围内，未观察到复发。
这是Preserflo微型分流器手术后首次报道的RPE撕裂和浆液性视网膜脱离病例。这些发现突出表明，即使未达到绝对低眼压，眼压的快速显著降低也可能破坏脉络膜循环和RPE完整性, 特别是在有易感因素的眼中，如特应性皮炎和长期使用类固醇。早期识别脉络膜脱离并及时干预以提高眼压对于预防威胁视力的并发症至关重要。
