Delayed-Onset Retrobulbar Hemorrhage and Glaucoma Drainage Device Extrusion in a Patient on Anticoagulation: A Case Report

Both retrobulbar hemorrhage and plate extrusion are uncommon complications after implantation of a glaucoma drainage device (GDD). There are no published reports on extrusion of an Ahmed glaucoma valve after delayed-onset retrobulbar hemorrhage in Korea. Herein, we report a case of spontaneous extrusion of a GDD after delayed-onset retrobulbar hemorrhage in a patient on anticoagulation. The case was a 72-year-old man with open-angle glaucoma and proliferative diabetic retinopathy, as well as systemic hypertension, atrial fibrillation, congestive heart failure due to coronary heart disease, and chronic kidney disease, who underwent combined Ahmed glaucoma valve implantation and cataract extraction surgery in his right eye. The body remained in position with control of intraocular pressure for 2 months. On day 67 (5 days post-coronary artery bypass surgery), he complained of decreased visual acuity, periorbital swelling, bloody discharge, and limited extraocular movement. One month later, the body was extruded with a scleral flap tear. Therefore, delayed-onset retrobulbar hemorrhage should be kept in mind in patients on anticoagulants after insertion of a GDD.