Journal of Steroids & Hormonal Science

A Case of Bilateral Choroidal Effusion Following Implantation of XEN Gel Stent

Asher^{* *}Correspondence: Asher, Department of Medicine, Freie University of Berlin, Berlin, Germany, Email:

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Introduction

With secondary morphological alterations in the optic nerve head and retinal nerve fiber layer, glaucoma is a chronic, progressive neurodegenerative optic neuropathy that affects the retina. Strictly speaking, problems in the visual field are connected to ganglion cell loss. The goal of treating glaucoma is to reduce Intraocular Pressure (IOP), which is the only therapy strategy known to slow the disease's progression. The optimal IOP for each patient can potentially be determined based on clinical information like the visual field, the shape of the optic nerve head, and IOP. If the patient is older or has an early to moderate level of impairment, the target IOP will be higher; if the patient is younger or has a moderate to advanced level of damage, the target IOP will be lower. Prostaglandins, which increase uveal scleral outflow, beta blockers, topical carbonic anhydrase inhibitors, and alfa2 agonists, which decrease aqueous humour production and increase trabecular outflow, are the four main drug classes used in topical medical treatment. Two options exist when the optimal IOP cannot be reached medically: Laser treatment, which lowers the IOP by around 20% and produces results after a month, or surgery.

Description

Trabeculectomy, the earliest and still most popular filtering glaucoma surgery type, is recommended for younger patients over Minimally Invasive Glaucoma Surgery (MIGS), which is less efficient in lowering IOP and is not a filtering procedure. One of the best methods for regulating and lowering IOP is glaucoma filtering surgery; however there have been a number of postoperative issues noted. Differentiating between early postoperative problems requires recognising changes in anterior chamber depth, IOP levels, and bleb morphology. A possible consequence of glaucoma surgery is serous Choroidal Detachment (CD), often referred to as choroidal effusion; it typically happens when there is considerable postoperative hypotony. It's possible that the hydrostatic pressure difference between the hypotonous eye and choroidal arteries and the choriocapillaris causes serous fluid from the choriocapillaris to accumulate in the virtual gap between the choroid and sclera (suprachoroidal space). The most common time for CDs to appear is 2 days-5 days following glaucoma surgery. Large CDs can result in blurred vision, restricted peripheral vision, sporadic headaches, and/or nausea, although tiny and peripheral effusions are frequently asymptomatic, with unaltered visual acuity and little to no anterior chamber shallowing. IOP is often low on examination, and the anterior chamber is shallow because the lens-iris diaphragm has shifted anteriorly. Through the use of fundus analysis, CDs, which are frequently seen in the periphery and have a multilobed appearance and morphology as a result of a tenacious attachment of the choroid to the vortex vein sites, can be directly observed. On B scan ultrasonography, fluid-filled lobes of CDs trans illuminate (Hagen’s sign), which allows them to be separated from hemorrhagic detachments, which appear echo dense. Most effusions resolve on their own when early wound healing, bleb development, and the preoperative effects of glaucoma drugs fade. The first line of medical treatment for persistent choroidal effusion includes addressing the underlying causes of hypotony, using topical corticosteroids, rotating the lens iris diaphragm, and applying cycloplegic eye drops to deepen the anterior chamber. Prednisone 1 mg, tapered gradually until resolution, may be administered as an oral glucocorticoid in severe cases that are resistant to topical treatments. Intracameral air and/or cohesive or ultra cohesive viscoelastic material may be injected via paracentesis to rebuild the anterior chamber if it is exceedingly shallow or flat. New devices have been created with the goal of reducing glaucoma surgery complications and lowering IOP in a safer and less traumatic way, and drainage procedures previously reserved for complex glaucoma cases or after unsuccessful trabeculectomy is now frequently the first surgical option.

Conclusion

For instance, the XEN45 gel stent shunts aqueous humour from the anterior chamber to a filtering bleb in the subconjunctival area. It is a 6 mm hydrophilic tube contained in a disposable inserter made especially for an ab-interno surgical technique. Although its tiny inner lumen (45 m) should theoretically prevent early postoperative hypotony, post-trabeculectomy problems might still develop after shunting procedures, with the incidence of CD following the implantation of the XEN45 gel stent.