The Role of Endoscopic Cyclophotocoagulation as a Primary Alternative Treatment for Patients at Risk of Ocular Hypotony: A Case Report

Endoscopic cyclophotocoagulation (ECP) offers a viable alternative for managing advanced primary open-angle glaucoma (POAG) in patients at risk of ocular hypotony. We describe a case of a successful outcome with ECP in a patient who developed ocular hypotony secondary to Preserflo surgery. A 93-year-old South Asian male experienced significant visual field deterioration and ocular hypotony following Preserflo surgery on the left eye, complicated by a severe cough from COVID-19. ECP was successfully utilized in the at-risk fellow eye, demonstrating stable intraocular pressures with reduced dependency on glaucoma medications over a 10-month follow-up period. Our findings suggest that ECP may be a preferable initial approach in managing POAG patients at elevated risk of hypotony or non-attendance, offering a safer alternative with comparable efficacy to traditional filtration surgeries. This case highlights the importance of selecting appropriate glaucoma interventions based on individual risk profiles. It underscores the necessity of strict postoperative follow-ups, particularly in the context of potential complications from systemic illnesses like COVID-19.