Gas Tamponade Improved Cilio-Choroidal Effusion Induced by an Ab Interno Trabeculotomy with a Microhook: Two Cases

Abstract

Purpose

We treated two patients with ciliary detachment due to an ab interno trabeculotomy. The ciliary detachment was improved by the use of sulfur hexafluoride (SF₆) gas or octafluoro propane (C₃F₈) tamponade.

Patients and Methods

Patient 1 was a 52-year-old Brazilian man with primary open angle glaucoma (POAG). His preoperative intraocular pressure (IOP) was 29 mmHg. Patient 2 was a 57-year-old Japanese woman with POAG. Her preoperative IOP was 35 mmHg. Both patients underwent an ab interno trabeculotomy with a microhook. They caused ciliary detachment as a postoperative complication. We could observe their ciliary detachment with anterior segment optical coherence tomography (AS-OCT). Hypotony persisted for 2 months and the patients’ ciliary detachment had not improved. They each underwent a pars plana vitrectomy (PPV) with simultaneous 20% SF₆ filling.

Results

In Patient 1, the use of the SF₆ gas tamponade successfully attached the ciliary body. His IOP was increased to 30 mmHg after this resolution of the ciliary detachment. He underwent additional tube shunt surgery. For Patient 2, the SF₆ gas tamponade improved the ciliary detachment but the ciliary body could not be attached. We injected 0.6 cc of 100% C₃F₈ gas into the vitreous cavity, and this gas tamponade was able to attach the ciliary body.

Conclusion

AS-OCT is very useful to evaluate ciliary detachment. PPV+Gas tamponade can be a treatment option for ciliary detachment.

Keywords:

• ab interno trabeculotomy
• ciliary detachment
• cyclodialysis
• tamponade
• microhook

Abbreviations

MIGS, minimally invasive glaucoma surgery; IOP, intraocular pressure; BCVA, best-corrected visual acuity; AS-OCT, anterior segment optical coherence tomography; UMB, ultrasound biomicroscopy; NSAIDs, non-steroidal anti-inflammatory drugs; PPV, pars plana vitrectomy; SF₆, sulfur hexafluoride; SLT, selective laser trabeculoplasty; IOL, intraocular lens; C₃F₈, octafluoro propane.

Data Sharing Statement

The datasets in our study are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

All procedures were performed in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethical approval is not required for this case report in accordance with national guidelines. A written informed consent form was obtained from the patient to publish these data and images.

Consent for Publication

We consent to publication.

Author Contributions

M.O, H.A and N.T wrote this paper and made figures. N.T and S.Y performed the surgeries. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

No potential conflict of interest was reported by the authors.

Additional information

Funding

No funding was received.