Posters

Postoperative suprachoroidal haemorrhage after Xen surgery – the risk still exists with MIGS

Poster Details

First Author: A.Karimi UK

Co Author(s):    D. Lindfield                    

Abstract Details

Purpose:

Minimally invasive glaucoma surgery (MIGS) is designed to be a safer, less invasive and more predictable method of reducing intraocular pressure (IOP) compared to traditional filtration surgery. Xen (Allergan Inc.) has shown a comparable or slightly superior safety profile to trabeculectomy, albeit no prospective head-to-head study has been published to date. We describe a case of suprachoroidal haemorrhage following what was predicted to be ‘routine’ Xen surgery but in the presence of anticoagulation.

Setting:

A retrospective notes review at a district general hospital in Surrey, UK.

Methods:

An 86-year-old pseudophakic male with primary open angle glaucoma had inadequately controlled IOP and progressive visual field loss despite four topical agents. The patient was anticoagulated with rivaroxaban for atrial fibrillation and cardiology advised anticoagulant could not be stopped for surgery. Risk:benefit discussion of surgery versus no further intervention, and of trabeculectomy versus Xen was undertaken with the patient. Xen surgery augmented with Mitomycin C (MMC) was ultimately performed by a consultant ophthalmic surgeon with a subspecialty interest in glaucoma

Results:

Pre-op BCVA was 6/9 and IOP 19. There were no intraoperative complications, glaucoma drops were stopped and standardised postop medications commenced. At Day 1 postop, a shallow anterior chamber (AC), IOP of 8, choroidal effusion and hypotonous maculopathy were found therefore Atropine 1% BD commenced. At Day 5, the patient rolled over in bed and felt severe eye pain. BCVA was light perception and a suprachoroidal haemorrhage was found. Following AC viscoelastic injection, nocturnal cyclopentolate 1%, discussion of surgical evacuation and eventual conservative management, complete resolution of the suprachoroidal haemorrhage occurred. Final BCVA was 6/6 and IOP 14 on Latanoprost.

Conclusions:

Suprachoroidal haemorrhage can occur after any intraocular procedure. Rates following cataract surgery are very low (0.04%) and following trabeculectomy rates are 0.6-1.4%. Our case is a reminder that glaucoma surgery, even when ‘minimally invasive’, carries the risk of a potentially sight-threatening haemorrhagic complication, due to a reduction in IOP. Patients at higher risk of such complications (e.g. on anticoagulation) need to be identified, and require appropriate pre-operative counselling. Prompt identification and management including raising IOP early can help tamponade the haemorrhage and improve outcomes.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented