Outpatient intracameral viscosurgical device reinflation for early hypotony after PreserFlo MicroShunt implantation: a case series

To describe a simple and reproducible stepwise outpatient management approach using intracameral high-viscosity ophthalmic viscosurgical device (OVD) reinflation for early Seidel-negative hypotony with shallow anterior chamber (AC) and choroidal detachment (CD) after PreserFlo MicroShunt implantation. This retrospective case series included three consecutive pseudophakic glaucoma eyes that developed Seidel-negative hypotony (lowest intraocular pressure [IOP] 3–5 mmHg) with shallow AC and CD in the early postoperative period after PMS implantation (including one case after bleb revision). In all eyes, a fixed initial small volume (0.2 mL) of high-viscosity or viscoadaptive sodium hyaluronate was injected intracamerally at the slit lamp or under the operating microscope to restore AC depth and IOP. AC reformation and CD resolution were achieved within 1–4 days without additional surgical intervention. No clinically evident corneal endothelial decompensation, visually significant IOP spikes (≥20 mmHg), or loss of visual acuity occurred during follow-up. and Importance: Small-volume intracameral OVD reinflation appears to provide a simple, reproducible, and minimally invasive first-line option for early Seidel-negative hypotony after PMS implantation. A stepwise outpatient management approach may help standardize clinical decision-making for PMS-related shallow AC and CD, potentially reducing the need for reoperation while maintaining IOP control.