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Title

Kissing choroids following Xen® gel stent implantation

Purpose	To describe a case of massive choroidal detachment (CD) following Xen® implantation.
Methods	A 86 year old pseudophakic male with pseudoexfoliative glaucoma was referred to our service with massive CD following Xen® implantation. Presurgery, he presented with an anterior uveitis with high intraocular pressure (IOP) of 50 mmHg. Because IOP was uncontrolled despite maximal topical therapy and acetazolamide, a Xen® was implanted. Over the course of the first postoperative days he developed a progressive CD resulting in kissing choroids by day 3. An anterior chamber repair (AC) was performed using Viscoat®. On day 5 IOP was 9mmHg with a Viscoat® maintained central AC, though peripheral iridocorneal touch, and a well-formed filtration bleb. B-scan showed a massive CD and a localised choroidal hemorrhage at the level of the optic disc. Subchoroidal viscoelastic tamponading the hemorrhage was suspected. A non-surgical approach was taken as it would be difficult to remove it through a drainage cannula. Tropicamide was added to the treatment.
Results	Over the next month he was regularly monitored with B-scan. The CD resolved slowly but completely. And his VA recovered.
Conclusion	Although micro invasive glaucoma surgery is considered safer similar postoperative complications can occur. The extremely high IOP preoperative and a ciliairy shutdown due to uveitis may have contributed to the aggressive clinical course. We suspect that in this case viscoelastic penetrated the subchoroidal space during the AC repair through a surgically induced cleft around the stent. Hence the choroidal hemorrhage was small, the blood remaind separated from the clear liquid in the bullae and CD resolved very slowly with regaining of VA.
Conflict of interest	No

Authors 1

Last name	DAM
Initials	J
Department	UZLeuven

Authors 2

Last name	MELARD
Initials	JC
Department	St Pierre
City	Ottignies

Authors 3

Last name	VANDEWALLE
Initials	E
Department	UZLeuven

Authors 4

Last name	STALMANS
Initials	I
Department	UZLeuven

Authors 5

Last name	STALMANS
Initials	P
Department	UZLeuven