Interference of Descemet's Membrane with Aqueous Humor Drainage via an ExPRESS Mini Shunt

PURPOSE: To describe a case in which Descemet's membrane interfered with aqueous humor drainage through an ExPRESS mini shunt. This problem was successfully solved by Nd:YAG laser membranotomy. CASE REPORT: A 70-year-old male, diagnosed with corticosteroid-induced glaucoma in his right eye, presented to our hospital. Topical betamethasone treatment was discontinued, and the patient was treated with intravenous D-mannitol and acetazolamide, followed by oral acetazolamide, oral potassium L-aspartate, topical dorzolamide hydrochloride, topical carteolol hydrochloride, and topical latanoprost. However, his right intraocular pressure (IOP) remained elevated. We performed ExPRESS shunt surgery in the patient's right eye. His postoperative IOP was initially within the normal range, but it reincreased 1 month after surgery. We found that the Descemet's membrane was interfering with both the primary (axial) and reserve orifices at the tip of the ExPRESS mini shunt. Nd:YAG laser membranotomy was performed and the patient's IOP again improved without any other medical treatment. CONCLUSION: Descemet's membrane interfered with aqueous humor drainage via ExPRESS mini shunt, causing an increased IOP, which was resolved by Nd:YAG laser membranotomy.