Case study: Late hypotony can occur after viscocanalostomy

Late hypotony syndrome is a potential complication of viscocanalostomy, particularly in patients with myopia and previous cyclodestructive procedures, according to a case study.

Bella Gavrilova and colleagues described the case of a 55-year-old woman with high myopia who had uncontrolled pigmentary open-angle glaucoma despite laser trabeculoplasty and a cyclodestructive procedure. In a further effort to control IOP the patient underwent uneventful viscocanalostomy. Postoperatively, her IOP ranged between 9 mm Hg and 17 mm Hg with steroid use, but it became unstable with reduction of steroids to three times a day. The patient developed hypotony in postoperative month 4.

“The steroid response at first observed indicated additional outflow via the trabecular meshwork,” the authors said in the August issue of Journal of Glaucoma. “After some months it could not be provoked any longer, leaving us to consider whether a gradual change in the trabecular meshwork hinders steroid medication changing aqueous outflow facility.”