J Korean Ophthalmol Soc.  2023 May;64(5):451-457. 10.3341/jkos.2023.64.5.451.

A Case of Macular Serous Retinal Detachment after Ahmed Valve Implantation in an Eye with Pachychoroid

• Kim E
• Byon I
• Lee J

• KMID: 2542184
• DOI: http://doi.org/10.3341/jkos.2023.64.5.451

Abstract

Purpose
We report a case of macular, serous retinal detachment associated with hypotony in a patient with pachychoroid disease developing after Ahmed valve implantation.
Case summary
A 77-year-old male visited our clinic with uncontrolled intraocular pressure (IOP; 32 mmHg) in his left eye despite maximal tolerable medical therapy. A prolapsed vitreous filled the anterior chamber. Swept-source optical coherence tomography (SS-OCT) revealed that the subfoveal choroidal thickness was about 510 μm, indicating pachychoroid. Vitrectomy was performed to remove the prolapsed vitreous. The IOP remained 32 mmHg 3 weeks after vitrectomy. Ahmed valve implantation was performed and hypotony developed 10 days postoperatively. Choroidal detachment was apparent and SS-OCT revealed macular accumulation of subretinal fluid. The subfoveal choroidal thickness increased to a level beyond the SS-OCT measurement range. Partial tube ligation was performed to treat the hypotony 18 days after Ahmed valve implantation; the IOP decreased to 14 mmHg at 6 weeks postoperatively. The macular, serous retinal detachment disappeared and the subfoveal choroidal thickness fell to the preoperative value.
Conclusions
Hypotony after Ahmed valve implantation can manifest as serous retinal detachment under the fovea accompanied by an increase in choroidal thickness in an eye with underlying pachychoroid.

Keyword

Ahmed valve implantation, Choroidal detachment, Hypotony maculopathy, Pachychoroid, Tube ligation