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

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.