A patient with a past ocular history of primary open angle glaucoma who underwent cataract extraction and trabeculectomy in the right eye and cataract extraction in the left eye presented for evaluation of high intraocular pressure in both eyes. Visual acuity is 20/25 and 20/20. Intraocular pressures are 18 OD and 25 OS on dorzolamide-timolol every 12 hours and bimatoprost at bedtime in both eyes. Dilated fundus exam is notable for significant cupping in both eyes. Visual field exam showed superior arcuate and inferior arcuate defects in both eyes. The patient underwent non-valved glaucoma drainage implant in the left eye which was complicated by a flat anterior chamber, hypotony, and choroidal effusions. She then underwent tube revision with occlusion of tube with vicryl suture. The right eye also needed surgery which was modified with a non-valved glaucoma drainage implant implant occluded with a vicryl suture and an intraluminal stent. Post-operatively, pressures were controlled with topical glaucoma drops. After the vicryl dissolved, intraocular pressures were high and the intraluminal stent was pulled resulting in a step wise lowering of pressure and no hypotony. The patient is currently doing well with low pressures in both eyes.
Presentation Date: 04/13/2023
Issue Date: 04/21/2023
Continuing Medical Education (CME)