Recurrent, Delayed-Onset Hyphema Following iStent Inject Managed With Device Removal: A Case Report

Minimally invasive glaucoma surgeries have become increasingly popular in recent years, with the iStent Inject trabecular micro-bypass device (Glaukos, Laguna Hills, CA) being a well-tolerated treatment option for mild to moderate glaucoma, available for placement at the time of cataract surgery. While there have been reports of hyphema in the immediate postoperative period, there is little information available regarding etiology and management of delayed-onset, recurrent hyphema following iStent Inject placement. We present a case of recurrent hyphema occurring after iStent Inject placement and describe successful management with surgical removal of the device. Since we observed a reflux of heme originating from the site of stent placement into the anterior chamber intraoperatively when the intraocular pressure was lowered, we hypothesize that placement of the device into a collector channel allowed for influx of heme when the intraocular pressure dropped below episcleral venous pressure.