Ab Interno Tube Occlusion for Postoperative Hypotony in a Patient With an Ahmed Glaucoma Drainage Device

Purpose:To report a case of Ahmed glaucoma valve-induced hypotony that was successfully managed with postoperative intraluminal stenting of the aqueous shunt tube.Patient and Methods:We describe a 68-year-old man with advanced uveitic glaucoma with an intraocular pressure (IOP) of 25mmHg in the left eye. The patient initially responded well to an Ahmed glaucoma valve implant, but at 10 weeks postimplantation, the patient underwent cataract surgery and developed persistent hypotony, choroidal folds, and decreased vision.Results:Before partial occlusion of the aqueous shunt tube, the patient had an IOP of 3mmHg and a best-corrected visual acuity (BCVA) of 20/60. Following intraluminal stenting of the aqueous shunt tube with 4-0 polypropylene suture (Prolene; Ethican), IOP rose from 7 to 10mmHg, BCVA improved to 20/30, and the choroidal folds resolved; IOP and BCVA remained stable through 1 year of follow-up and no additional surgical or pharmacological interventions were required.Conclusions:Aqueous shunt-induced hypotony can be successfully managed with intraluminal stenting and should be considered before tubal ligation or shunt removal.