Vitreous hemorrhage following CyPass® glaucoma stent surgery

Abstract EN

Objective: To report a previously unpublished complication of CyPass® glaucoma stent placement in a patient undergoing combined cataract and glaucoma surgeries.

This case occurred prior to voluntary withdrawal of the CyPass® device from the market.

Case Description: A 70-year-old Hispanic male with a history of advanced pseudoexfoliation glaucoma left eye (OS) > right eye (OD) presented to the North Texas Veterans Affairs Medical Center with disease progression despite escalation to maximum medical therapy.

His maximum intra-ocular pressure (IOP) prior to treatment was 29 mm Hg in OD and 60 mm Hg in OS.

Given the presence of a visually significant cataract in OS with advanced glaucoma that was progressing despite maximum medical therapy, a decision was made to pursue cataract phacoemulsification in conjunction with insertion of a CyPass® stent device in OS.

The patient was consented prior to surgery.

Postoperatively, his IOP dropped to as low as 4 mm Hg, followed by hyphema as well as a dense vitreous hemorrhage.

Appropriate placement of the stent was confirmed by ultrasound biomicroscopy, gonioscopy, and anterior segment optical coherence tomography (OCT).

The hypotony, hyphema and vitreous hemorrhage all resolved with conservative medical management by the time the patient was seen again one month later.

Conclusions: It is important for surgeons to be aware of even less common complications of micro invasive glaucoma surgery (MIGS) procedures.

In our case, the patient developed a complication that had previously not been described.

While this case resolved with conservative medical management, this case illustrates that it is important to appropriately assess pre-operative risk factors and confirm appropriate placement of a MIGS device postoperatively.-