A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation
Jason Dossantos, Jella An
Keywords :
Case report, Hydrus microstent, Obstructive peripheral anterior synechiae, OMNI canaloplasty, Phacoemulsification, Psoriatic arthritis, Uveitis
Citation Information :
Dossantos J, An J. A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation. J Curr Glaucoma Pract 2024; 18 (1):37-41.
Purpose: This study seeks to highlight and explore the occurrence of uveitis with obstructive peripheral anterior synechiae (PAS) after a combined OMNI canaloplasty and Hydrus microstent implantation with phacoemulsification, particularly in a patient with a background of psoriatic arthritis.
Observations: A 56-year-old male with a medical history of psoriatic arthritis (in remission for 10 years) and primary open-angle glaucoma (POAG) underwent a combined OMNI canaloplasty and Hydrus microstent with phacoemulsification. The surgical procedure was uncomplicated. However, within 2 weeks postsurgery, the patient presented with severe symptoms, including uveitis, elevated intraocular pressure (IOP), and a significant reduction in best-corrected visual acuity (BCVA). This postoperative response was unexpected, especially given the lack of any past history of uveitis in the patient. The complication, potentially influenced by the patient's history of psoriatic arthritis, led to the need for additional interventions, including the implantation of an Ahmed glaucoma valve.
Conclusion: This case underscores the potential for postoperative complications, specifically uveitis with obstructive PAS, following combined OMNI canaloplasty and Hydrus microstent with phacoemulsification, especially in patients with a history of autoimmune diseases. Careful preoperative history, postoperative monitoring, and a nuanced approach to surgical planning are crucial. The association between systemic inflammatory conditions and ocular complications warrants deeper exploration to ensure optimal patient care.
Samuelson TW, Chang DF, Marquis R, et al. A Schlemm canal microstent for intraocular pressure reduction in primary open-angle glaucoma and cataract: the HORIZON study. Ophthalmology 2019;126(1):29–37. DOI: 10.1016/j.ophtha.2018.05.012
Gandolfi SA, Ungaro N, Ghirardini S, et al. Comparison of surgical outcomes between canaloplasty and schlemm's canal scaffold at 24 months’ follow-up. J Ophthalmol 2016;2016:3410469. DOI: 10.1155/2016/3410469
Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa JM, et al. A Randomized trial of a Schlemm's canal microstent with phacoemulsification for reducing intraocular pressure in open-angle glaucoma. Ophthalmology 2015;122(7):1283–1293. DOI: 10.1016/j.ophtha.2015.03.031
Ahmed IIK, De Francesco T, Rhee D, et al. Long-term outcomes from the HORIZON randomized trial for a Schlemm's canal microstent in combination cataract and glaucoma surgery. Ophthalmology 2022;129(7):742–751. DOI: 10.1016/j.ophtha.2022.02.021
Ahmed IIK, Fea A, Au L, et al. A Prospective randomized trial comparing Hydrus and iStent microinvasive glaucoma surgery implants for standalone treatment of open-angle glaucoma: the COMPARE study. Ophthalmology 2020;127(1):52–61. DOI: 10.1016/j.ophtha.2019.04.034
Hirsch L, Cotliar J, Vold S, et al. Canaloplasty and trabeculotomy ab interno with the OMNI system combined with cataract surgery in open-angle glaucoma: 12-month outcomes from the ROMEO study. J Cataract Refract Surg 2021;47(7):907–915. DOI: 10.1097/j.jcrs.0000000000000552
Dickinson A, Leidy L, Nusair O, et al. Short-term outcomes of Hydrus microstent with and without additional canaloplasty during cataract surgery. J Glaucoma 2023;32(9):769–776. DOI: 10.1097/IJG.0000000000002245
Chung AS, Yaniv S, Gottlieb AB. Psoriatic eye manifestations. Psoriasis Forum 2011;17a(3):169–179. DOI: 10.1177/247553031117a00301
Caspi RR. A look at autoimmunity and inflammation in the eye. J Clin Invest 2010;120(9):3073–3083. DOI: 10.1172/JCI42440
Seow WH, Lim CHL, Lim BXH, et al. Uveitis and glaucoma: a look at present day surgical options. Curr Opin Ophthalmol 2023;34(2):152–161. DOI: 10.1097/ICU.0000000000000940
Freedman SF, Rodriguez-Rosa RE, Rojas MC, et al. Goniotomy for glaucoma secondary to chronic childhood uveitis. Am J Ophthalmol 2002;133(5):617–621. DOI: 10.1016/S0002-9394(02)01344-2
Bohnsack BL, Freedman SF. Surgical outcomes in childhood uveitic glaucoma. Am J Ophthalmol 2013;155(1):134–142. DOI: 10.1016/j.ajo.2012.07.008
Anton A, Heinzelmann S, Neß T, et al. Trabeculectomy ab interno with the Trabectome® as a therapeutic option for uveitic secondary glaucoma. Graefes Arch Clin Exp Ophthalmol 2015;253(11):1973–1978. DOI: 10.1007/s00417-015-3102-3
Miller VJ, Young CEC, SooHoo JR, et al. Efficacy of goniotomy with Kahook dual blade in patients with uveitis-associated ocular hypertension. J Glaucoma 2019;28(8):744–748. DOI: 10.1097/IJG.0000000000001298
Kalin-Hajdu E, Hammamji K, Gagné S, et al. Outcome of viscodilation and tensioning of Schlemm's canal for uveitic glaucoma. Can J Ophthalmol 2014;49(5):414–419. DOI: 10.1016/j.jcjo.2014.07.001