A Case of Delayed-onset Hemorrhagic Choroidal Detachment after PreserFlo Microshunt Implantation in a Glaucoma Patient under Anticoagulant Therapy: Journal of Glaucoma

E. Micheletti, I. Riva, C. Bruttini, L. Quaranta

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose:To describe a case of delayed-onset hemorrhagic choroidal detachment (HCD) in a patient affected by primary open-angle glaucoma (POAG) undergone PreserFlo Microshunt implantation.Case Report Description:A 76-year-old patient with POAG, under treatment with Dabigatran (a novel oral anticoagulant), underwent an uncomplicated PreserFlo Microshunt implantation in the left eye. In the first postoperative day, intraocular pressure (IOP) was 6 mm Hg, conjunctival bleb was diffuse, anterior chamber (AC) deep, and device correctly positioned. Twelve days after surgery, the patient had emergency access complaining severe ocular pain and sudden vision loss. Ophthalmological evaluation revealed shallow AC and an IOP of 50 mm Hg. The fundus examination revealed almost kissing HCD.Outcome:Immediate topical treatment with atropine, aqueous humor suppressants, and corticosteroids was started. Because of high IOP, ocular pain, and the presence of almost kissing HCD, surgical drainage of suprachoroidal hemorrhage and removal of PreserFlo Microshunt were performed. An improvement of the clinical condition was observed in the following postoperative days, with partial resolution of the HCD and a decrease of the IOP. On the third postoperative day, there was a worsening of the HCD, with a reduction of the AC depth and IOP elevation. HCD was drained through the previously performed sclerotomies, associated with pars-plana vitrectomy and silicone-oil tamponade. HCD completely resolved during the following 6 weeks, with IOP reduction and partial improvement of visual acuity.Conclusion:Great attention must be taken in patients with glaucoma under treatment with a novel oral anticoagulant, also when planning PreserFlo Microshunt implantation. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)E87-E90
JournalJ. Glaucoma
Volume29
Issue number8
DOIs
Publication statusPublished - Aug 2020

Keywords

  • choroidal detachment
  • glaucoma
  • PreserFlo
  • suprachoroidal hemorrhage
  • trabeculectomy
  • agents acting on the eye
  • aqueous humor suppressant
  • atropine
  • betamethasone
  • bimatoprost
  • dabigatran
  • dorzolamide plus timolol
  • unclassified drug
  • antihypertensive agent
  • antithrombin
  • glucocorticoid
  • mydriatic agent
  • aged
  • anterior eye chamber
  • Article
  • bleeding
  • case report
  • Caucasian
  • choroid detachment
  • clinical article
  • clinical outcome
  • conjunctiva
  • conjunctival bleb
  • disease exacerbation
  • disease severity
  • echography
  • endotamponade
  • eye pain
  • hemorrhagic choroidal detachment
  • human
  • intraocular hypertension
  • intraocular pressure
  • male
  • open angle glaucoma
  • ophthalmoscopy
  • pars plana vitrectomy
  • postoperative period
  • priority journal
  • sclerotomy
  • silicon oil tamponade
  • surgical drainage
  • thromboembolism
  • treatment response
  • visual acuity
  • visual impairment
  • visual system examination
  • adverse device effect
  • adverse event
  • atrial fibrillation
  • choroid hemorrhage
  • combination drug therapy
  • drug effect
  • glaucoma drainage implant
  • oculoplethysmography
  • pathophysiology
  • physiology
  • prosthesis implantation
  • Aged
  • Antihypertensive Agents
  • Antithrombins
  • Atrial Fibrillation
  • Atropine
  • Betamethasone
  • Choroid Hemorrhage
  • Choroidal Effusions
  • Dabigatran
  • Drug Therapy, Combination
  • Glaucoma Drainage Implants
  • Glaucoma, Open-Angle
  • Glucocorticoids
  • Humans
  • Intraocular Pressure
  • Male
  • Mydriatics
  • Prosthesis Implantation
  • Tonometry, Ocular

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