Supraciliary Microstent Revision in a Patient with Corneal Edema and Primary Open Angle Glaucoma: A Case Report

A 56-year-old Hispanic male individual with moderate primary open-angle glaucoma on maximal tolerated topical therapy with recent visual field progression presented with excessive glare due to cataract in the right eye. The patient underwent uncomplicated phacoemulsification with supraciliary microstent implantation. Ten weeks postoperatively, he presented with global Descemet folds and focal corneal edema overlying the CyPass implant despite apparent adequate implant position (1 retention ring visible). The revision proved challenging as the anterior chamber portion of the implant was short. Nonetheless, the device was trimmed under gonioscopic view using intraocular lens cutting scissors and a Sinskey hook. Postoperatively, the implant was flush with the iris root with a patent lumen. Bilateral global guttae indicating unrecognized Fuchs endothelial corneal dystrophy diagnosed postoperatively may have contributed to the corneal edema that improved after the revision.