This patient had an uncomplicated Ahmed tube surgery 2 weeks prior, but he did not stop his IOP-lowering medication nor take his prescribed anti-inflammatories and atropine.
His IOP was 4 mmHg, which led to choroidal detachments. The subretinal blood noted superotemporally is likely iatrogenic from an inadvertent overly deep suture used to secure the Ahmed explant.
Aggressive anti-inflammatories and atropine drops were started, and he was asked to stop all IOP-lowering drops.
The choroidals continued to resolve at 6 weeks as IOP continued to climb to 13mmHg. Five months post-op the choroidal detachment and subretinal blood completely resolved.
Learning Points:
Choroidal detachment is relatively common after glaucoma filtration surgery. Two mechanisms are believed to be at play:
(1) Hypotony allows fluid to accumulate in the suprachoroidal space
(2) Inflammation increases the choroidal capillary permeability.
The detached ciliary body may also produce less aqueous, thus creating a self-perpetuating hypotony.
