Intraluminal Insertion of 9-0 Nylon for Postoperative Choroidal Detachment After Preserflo MicroShunt Implantation: A Case Report

Preserflo MicroShunt (PMS) implantation is a minimally invasive surgical procedure for treating glaucoma. Postoperative hypotony, a common complication of PMS implantation, can be prevented and treated with 10-0 nylon insertion. In this report, we present a case of postoperative hypotony following PMS implantation that was treated with intraluminal insertion of 9-0 nylon. A 78-year-old woman with immunoglobulin G4 (IgG4)-related disease and nephrotic syndrome was being treated with oral steroids for more than 15 years. She developed steroid-induced glaucoma in both eyes. At presentation, her intraocular pressures (IOPs) were markedly elevated to nearly 40 mmHg, which caused severe visual dysfunction. We performed PMS implantation in both eyes. The postoperative IOP was maintained at 7-10 mmHg; however, the patient experienced severe choroidal detachment (CD) extending to the posterior pole and shallowing of the anterior chamber in both eyes. After inserting 9-0 nylon into the lumen of the PMS in both eyes, the IOP increased to 25-30 mmHg. Additionally, the CD completely resolved within a month of the procedure. The administration of glaucoma eye drops resulted in a sustained IOP of 15 mmHg. When the 9-0 nylon was removed in the left eye only, the IOP decreased to 8 mmHg, which caused the recurrence and persistence of CD for six months postoperatively. Insertion of 9-0 nylon into the lumen of a PMS may be effective for treating postoperative hypotony; however, future studies are warranted to evaluate the optimal timing for stent removal.