Severe Intraocular Pressure Elevation After Intracameral Healon 5 Viscoelastic Support for Postoperative Hypotony After XEN Gel Stent Insertion.

Bruynseels, Alice and Sii, Freda and Masood, Imran and Shah, Peter (2018) Severe Intraocular Pressure Elevation After Intracameral Healon 5 Viscoelastic Support for Postoperative Hypotony After XEN Gel Stent Insertion. Journal of glaucoma, 27 (4). e75-e76. ISSN 1536-481X.

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Abstract

PURPOSE

The purpose of this article was to describe (i) a novel case of severe intraocular pressure (IOP) elevation due to intracameral Healon 5 for management of early postoperative (post-op) hypotony following XEN Gel Stent insertion and (ii) the management of this complication.

MATERIALS AND METHODS

A case report.

RESULTS

A 52-year-old man, with primary open-angle glaucoma and suboptimal left IOP control on maximally tolerated medical therapy, was managed with XEN Gel Stent insertion at another tertiary eye unit. Post-op, the IOP was 2 mm Hg with a shallow anterior chamber (AC) and choroidal effusions. Intracameral injections of Provisc on post-op days 1 and 3 failed to reverse hypotony. At 1 week post-op, persistent clinically significant hypotony was managed with Healon 5 injection into the AC. Twelve hours later, the patient experienced significant pain and reduced vision and presented to a different tertiary eye unit, where left visual acuity was hand movements, IOP was 70 mm Hg with a deep AC (complete ophthalmic viscosurgical device fill with Healon 5) and a flat drainage bleb with no external drainage. Emergency AC washout of the Healon 5 was performed with resolution of symptoms, visual acuity, and IOP control.

CONCLUSIONS

We caution against the use of intracameral Healon 5 in the management of post-op hypotony following XEN Gel Stent insertion, given the potential risk for extreme IOP elevation and sight loss.

Item Type: Article
Subjects: WW Eyes. Ophthalmology
Divisions: Ambulatory Care > Ophthalmology
Related URLs:
Depositing User: Jennifer Manders
Date Deposited: 31 Oct 2019 14:11
Last Modified: 31 Oct 2019 14:11
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2535

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