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All Journal Medical Journal of Indonesia Ophthalmologica Indonesiana
Suryono, Astrianda Nadya
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Health Professions Medicine & Pharmacology Public Health

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A Watchful Eye: A Case Report on The Management of Hypotony Maculopathy after Non-Valved Glaucoma Drainage Device Implantation: Poster Presentation - Case Report - Resident Herdian, Felicia Sesih; Amanda, Lia; Ivanovna, Regina; Gunardi, Triana Hardianti; Yunard, Ardiella; Suryono, Astrianda Nadya
Majalah Oftalmologi Indonesia Vol 49 No S2 (2023): Supplement Edition
Publisher : The Indonesian Ophthalmologists Association (IOA, Perhimpunan Dokter Spesialis Mata Indonesia (Perdami))

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35749/b6ewfv90

Abstract

Introduction : Low intraocular pressure (IOP) and reduced visual acuity following glaucoma surgery have been linked to a serious complication known as hypotony maculopathy. Here, we report a case of hypotony maculopathy following glaucoma drainage implant which was successfully managed by a conservative approach utilizing oral and topical steroids, resulting in favorable outcomes. Case Illustration : A 25-year-old female with juvenile glaucoma presented with low IOP in the right eye (RE) following glaucoma drainage surgery using non-valved implant four months prior. Ophthalmic examination revealed a decrease of IOP (9mmHg to 4mmHg) and visual acuity (6/6 to 6/24). Fundus examination and optical coherence tomography (OCT) of macula was indicating hypotony maculopathy. All glaucoma medications were discontinued and the patient was given oral methylprednisolone 3x8 mg and topical prednisolone acetate three hourly for two months. Subsequent follow-up revealed an increase in IOP to 37mmHg and visual acuity improvement to 6/6. The patient was then given oral and topical antiglaucoma medications to maintain IOP control. Discussion : Hypotony and its related sequelae are more common with the non-valved drainage devices. Prompt intervention is crucial for improving visual outcomes. Treatment options include surgical and conservative approach. Closely monitored conservative therapy may also give favorable outcomes similar to surgical approach. Conclusion : In advanced cases of glaucoma, extremely low IOP is just as risky as a high IOP. Conservative therapy, including topical and oral corticosteroids, can be employed to reverse hypotony, at the expense of transient IOP rise, in corticosteroid-responsive patients. Restoring normal IOP in a timely manner may improve retinal function.
Xen® Gel Stent versus PreserFlo™ MicroShunt as a subconjunctival shunt devices in glaucoma: a systematic review Huda, Muhammad Khoirul; Suryono, Astrianda Nadya
Medical Journal of Indonesia Online First
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.258110

Abstract

BACKGROUND Glaucoma is the leading cause of irreversible blindness and is primarily managed by reducing intraocular pressure (IOP). Minimally invasive glaucoma surgeries, particularly subconjunctival shunt devices such as Xen® Gel Stent and PreserFlo™ MicroShunt, have emerged as alternatives to traditional trabeculectomy. This study aimed to evaluate their effectiveness in lowering IOP, reducing medication use, and assessing reinterventions and safety. METHODS A systematic review was conducted in accordance with Cochrane and PRISMA guidelines. Comprehensive literature searches were conducted across PubMed, Cochrane, EBSCOhost, and Google Scholar databases from the earliest available date to September 2023. Studies comparing Xen® Gel Stent and PreserFlo™ MicroShunt in adult patients with glaucoma were included. Data were extracted on study design, sample size, IOP outcomes, antiglaucoma medication use, reinterventions, and safety outcomes. Quality assessment was performed using the Newcastle-Ottawa Scale. RESULTS Of 5 European studies (2020–2023; 329 patients, 6–18 months of follow-up), 3 studies reported lower postoperative IOP with PreserFlo™ MicroShunt (11.8 [3.7] versus 13.6 [3.5] mmHg, p = 0.02; 10.3 [2.1] versus 14.2 [2.1] mmHg, p = 0.0005; 10.3 [3.2] versus 13.1 [6.4] mmHg, p = 0.019). Only one study noted fewer antiglaucoma medications with PreserFlo™ MicroShunt (0.2 [0.6] versus 1.1 [2.4], p = 0.04). Reinterventions including needling and bleb revisions were higher with Xen® Gel Stent (35.4% versus 11.5%; 20% versus 5%). Complication profiles varied, with hypotony more common in Xen® Gel Stent (6.5% versus 0%), hyphema more common with PreserFlo™ MicroShunt (7.7% versus 3.2%), and stent curling and migration more common with Xen® Gel Stent (15% versus 0%; 2% versus 0%), respectively. CONCLUSIONS Both Xen® Gel Stent and PreserFlo™ MicroShunt effectively lowered IOP and reduced medication burden in patients with glaucoma. PreserFlo™ MicroShunt may provide superior IOP control and fewer postoperative interventions. Further prospective studies in diverse populations are warranted.
Co-Authors Amanda, Lia Gunardi, Triana Hardianti Herdian, Felicia Sesih Muhammad Khoirul Huda Regina Ivanovna Yunard, Ardiella