Persistent hypotony following high-intensity focused ultrasound treatment in a glaucomatous eye

Abstract

We report the case of a 60-year-old female with primary angle-closure glaucoma, who presented with intraocular pressure (IOP) of 0 mmHg, significant cataract, and finger-counting vision in her left eye (LE) following high-intensity focused ultrasound (HIFU) treatment. She underwent LE cataract surgery combined with pars plana vitrectomy, membrane peeling, and silicon oil injection. Postoperatively, hypotony improved, and visual acuity improved to 20/160. One and a half years later, she underwent silicone oil removal (SOR) in view of recovered ciliary secretion and elevated IOP. Post-SOR, IOP remained elevated due to complete synechial closure secondary to prolonged hypotony and the patient is awaiting an incisional surgery. This case highlights the serious vision-threatening complications of persistent hypotony following HIFU treatment. We caution the surgeons regarding the use of HIFU in eyes with good visual potential and discuss the importance of understanding the safety and efficacy of a cycloablative procedure.

Keywords

• cycloablative procedures
• cyclodestructive procedures
• high-intensity focused ultrasound
• hypotony
• refractory glaucoma