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Management of Persistent Hypotony after Supraciliary CyPass® Implantation Using Argon Laser.

ABSTRACT: Purpose:To report a case and management of persistent hypotony with hypotony-induced maculopathy after CyPass® device implant. Background:The CyPass® was the first supraciliary ab interno device approved by FDA and commercially available. Efficacy studies showed adequate intraocular pressure (IOP)-lowering results in combination with phacoemulsification. Hypotony induced by suprachoroidal minimally invasive glaucoma surgery (MIGS) was reported to be lower than 3% in the population that comprised the COMPASS study. Case description:A 57-year-old female patient with mild open-angle glaucoma with maximum topical medical therapy who underwent sequential bilateral CyPass® implantation developed persistent hypotony. Device obstruction was induced through argon laser burns directed to the peripheral iris, and the device was no longer visible on follow-up examinations. Topical IOP-lowering medication was restarted (timolol-dorzolamide) and has since been controlled under 16 mm Hg, without progression on visual fields. Conclusion:Argon laser burns directed to the peripheral iris to induce synechiae development that produces device obstruction are an effective technique to manage persistent hypotony after supraciliary CyPass® implantation. Clinical significance:Here, authors show a novel approach for treatment of persistent hypotony secondary to CyPass® implantation. In the knowledge of the authors, this is the first report that describes a noninvasive management for this complication, and this case could help other physicians to manage similar cases. How to cite this article:Fernando DV-N, Díez-Cattini GF, Alfonso G-L, et al. Management of Persistent Hypotony after Supraciliary CyPass® Implantation Using Argon Laser. J Curr Glaucoma Pract 2019;13(3):116-118.

SUBMITTER: Fernando DV

PROVIDER: S-EPMC7221243 | biostudies-literature | 2019 Sep-Dec

REPOSITORIES: biostudies-literature

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Management of Persistent Hypotony after Supraciliary CyPass<sup>®</sup> Implantation Using Argon Laser.

Fernando Del Valle-Nava DV Díez-Cattini G F GF Alfonso García-López GL Francisco Ortega-Santana OS

Journal of current glaucoma practice 20190901 3

<h4>Purpose</h4>To report a case and management of persistent hypotony with hypotony-induced maculopathy after CyPass<sup>®</sup> device implant.<h4>Background</h4>The CyPass<sup>®</sup> was the first supraciliary <i>ab interno</i> device approved by FDA and commercially available. Efficacy studies showed adequate intraocular pressure (IOP)-lowering results in combination with phacoemulsification. Hypotony induced by suprachoroidal minimally invasive glaucoma surgery (MIGS) was reported to be lo ...[more]

PMID: 32431479

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Project description:BackgroundIn order to overcome the geometrical and physical limitations of conventional rotating and piezosurgery instruments used to perform bone osteotomies, as well as the difficulties in translating digital planning to the operating room, a stand-alone robot-guided laser system has been developed by Advanced Osteotomy Tools, a Swiss start-up company. We present our experiences of the first-in-man use of the Cold Ablation Robot-guided Laser Osteotome (CARLO®).MethodsThe CARLO® device employs a stand-alone 2.94-µm erbium-doped yttrium aluminum garnet (Er:YAG) laser mounted on a robotic arm. A 19-year-old patient provided informed consent to undergo bimaxillary orthognathic surgery. A linear Le Fort I midface osteotomy was digitally planned and transferred to the CARLO® device. The linear part of the Le Fort I osteotomy was performed autonomously by the CARLO® device under direct visual control. All pre-, intra-, and postoperative technical difficulties and safety issues were documented. Accuracy was analyzed by superimposing pre- and postoperative computed tomography images.ResultsThe CARLO® device performed the linear osteotomy without any technical or safety issues. There was a maximum difference of 0.8 mm between the planned and performed osteotomies, with a root-mean-square error of 1.0 mm. The patient showed normal postoperative healing with no complications.ConclusionThe newly developed stand-alone CARLO® device could be a useful alternative to conventional burs, drills, and piezosurgery instruments for performing osteotomies. However, the technical workflow concerning the positioning and fixation of the target marker and the implementation of active depth control still need to be improved. Further research to assess safety and accuracy is also necessary, especially at osteotomy sites where direct visual control is not possible. Finally, cost-effectiveness analysis comparing the use of the CARLO® device with gold-standard surgery protocols will help to define the role of the CARLO® device in the surgical landscape.

Dataset Information

Management of Persistent Hypotony after Supraciliary CyPass® Implantation Using Argon Laser.

Publications

Management of Persistent Hypotony after Supraciliary CyPass<sup>®</sup> Implantation Using Argon Laser.

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