Choroidal Detachment Following Trabeculectomy

Trabeculectomy, a filtration surgery for glaucoma, presents challenges in controlling filtration volume. On occasion, intraocular pressure may remain extremely low not only in the early postoperative period but persistently thereafter. In such instances, choroidal detachment may occur. This treatment approach is described. Furthermore, should intraocular pressure subsequently rise excessively, it can be controlled using the opposite method.

This glaucoma surgery was performed at Fukasaku Eye Institute Tokyo Roppongi by a single highly skilled ophthalmic surgeon. 

Preoperative IOP was 22 mmHg with visual acuity of 0.1. Severe visual field defects indicated end-stage glaucoma. A trabeculectomy with filtration surgery was performed initially. A loose three-suture pleural flap was created. IOP reduction was marked, with pressure reaching 3.4 mmHg. At two weeks post-operatively, choroidal detachment developed, causing the patient to report an extremely narrow visual field and difficulty seeing. At three weeks post-operatively, the conjunctiva was opened and three sutures were tightened on the scleral flap. This resulted in IOP of 21 mmHg and resolution of the choroidal detachment. Subsequently, one week later, two scleral flap sutures were cut using laser.

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After Torabeculectomy, IOP reduction was marked, with pressure reaching 3.4 mmHg. At two weeks post-operatively, choroidal detachment developed, causing the patient to report an extremely narrow visual field and difficulty seeing. Consequently, at three weeks post-operatively, the conjunctiva was opened and three sutures were tightened on the scleral flap. This resulted in an intraocular pressure of 21 mmHg and resolution of the choroidal detachment. Subsequently, one week later, two scleral flap sutures were cut using laser.

Intraocular pressure is 8 mmHg and remains stable. Visual acuity has improved slightly to 0.2.

 Trabeculectomy filtration surgery is highly effective for lowering intraocular pressure in glaucoma surgery. However, in some cases, intraocular pressure may become excessively low. In such instances, choroidal detachment may occur due to hypotony. Adding 10-nylon sutures to the scleral flap is effective for this, and the choroidal detachment also resolves. Furthermore, should this additional suture cause intraocular pressure to rise, further pressure reduction can be achieved by laser suture lysis to cut the 10-0 nylon suture.