VITREOUS PROLAPSE FOLLOWING CHOROIDAL EFFUSION AFTER AHMED GLAUCOMA VALVE SURGERY: A CASE REPORT
Published 2025 - 29th ESCRS Winter Meeting
Reference: CR03.03 | Type: Case Report (Cornea Day) | DOI: 10.82333/nm0q-x241
Authors: Nader Nassiri* 1 , Maryam Yadgari 1 , Kourosh Sheibani 2 , Sara Kavousnezhad 3
1Ophthalmology,Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences ,Tehran,Iran, Islamic Republic Of, 2Basir Eye Health Research Center,Tehran,Iran, Islamic Republic Of, 3Vanak Eye Surgery Center,Tehran,Iran, Islamic Republic Of
Purpose
To present a case of vitreous prolapse following choroidal effusion after Ahmed glaucoma valve surgery and its management.
Setting
Imam Hossein Medical Center, Tehran, Iran.
Report of case
A 53-year-old man with a history of glaucoma presented to our clinic for a routine followup examination. He had undergone previous uncomplicated cataract surgery in both eyes without vitreous loss several years ago and had been using Zilomole (timolol/dorzolamide), brimonidine, and latanoprost eye drops for primary open-angle glaucoma in both eyes.
Upon examination, the best-corrected visual acuity (BCVA) was 20/40 in the right eye (OD) and 20/60 in the left eye (OS). Slit lamp anterior segment examination revealed normal findings in both eyes. The IOP was 17 mmHg in OD and 28 mmHg in OS. Posterior chamber intraocular lenses were in place with an intact posterior capsule, and pseudophacodonesis was observed in OS. Fundoscopy showed a pink optic disk with sharp margins, and the cup-to-disk ratio was 0.7 in OD and 0.85 in OS, with other examination findings being normal. After further evaluation and in order to control IOP, the patient underwent Ahmed glaucoma valve shunt surgery for the left eye. During the first postoperative visit (1 day after surgery), slit lamp examination revealed mild anterior chamber (AC) reaction, and the Ahmed glaucoma valve tube was noted to be in place in the AC. A large vitreous prolapse extending from the posterior chamber to the anterior chamber was observed. The patient was hypotonic (IOP: 4 mmHg), and fundoscopy revealed a large choroidal effusion in the nasal and temporal retina. The patient did not report any visual symptoms.
The patient was treated with atropine and betamethasone eye drops. After one week, the choroidal effusion had resolved, and the vitreous prolapse had slightly decreased in size. During multiple follow-up visits over the course of 6 months, the vitreous prolapse remained in place without AC reaction or inflammation. No changes or discomfort were reported, and the BCVA remained 20/60 in OS.
Conclusion / Take home message
We presented a unique case of vitreous prolapse following choroidal effusion in a patient who underwent Ahmed glaucoma valve surgery. While delayed onset vitreous prolapse after cataract surgery has been reported, the occurrence in the context of choroidal effusion is rare. Further studies are warranted to better understand the pathogenesis and optimal management of delayed vitreous prolapse, particularly in the context of choroidal effusion.