AAO 2019 Video Program

    Purpose To describe a case of an obstructed ostia of a Hydrus Microshunt postoperatively and the use of a YAG laser to remove the iris tissue from the opening. Methods A patient with a history of a failed express shunt underwent a routine cataract surgery with Hydrus Microshunt implantation. IOP postop was 14 mmHg at 1 week and 1 month. At 3 months, IOP suddenly rose to 33 mmHg. Gonioscopic view revealed iris tissue blocking the lumen of the stent. A YAG laser and a gonioprism were used to remove iris tissue from the ostia of the shunt. A total of 22 shots at 3.5 mJ was used. Results Post YAG laser, the IOP came down immediately to 18 mmHg and then 14 mmHg at 1 week. Topical steroids were used for 1 week. The ostia remained open. A small microhyphema was seen at postop day 1 but resolved by 1 week. Conclusion The use of a YAG laser is a possible treatment option in cases where the iris obstructs the microshunt, resulting in increased IOP.