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Delayed blood reflux-related secondary open-angle glaucoma with ghost cells more than 3 years after ab-interno goniotomy

Year: 2026

Type: article

Abstract: Purpose: To report delayed blood reflux-related secondary open-angle glaucoma with a pathology-supported ghost-cell component more than 3 years after ab-interno goniotomy. Observations: A 73-year-old man with primary open-angle glaucoma underwent left ab-interno goniotomy using a Tanito microhook (TMH) over 120° about 45 months before presentation; a 1-mm hyphema was documented on postoperative day 1. IOP was 17.0 mmHg at 3 months, 14.0 mmHg at 1 year, 18.0 mmHg at postoperative month 36, and 15.3 mmHg at postoperative month 44, but increased to 45.3 mmHg approximately 2 weeks before admission and 45.1 mmHg at admission despite topical therapy. Gonioscopy showed an open angle with a small inferior hyphema, and B-scan showed no clinically evident vitreous hemorrhage. During early anterior chamber paracentesis/decompression, 0.1 mL of aqueous humor was aspirated for direct-smear examination with routine hematoxylin-eosin staining; during decompression/washout, blood-tinged reflux was observed from the nasal angle corresponding to the prior goniotomy site. Pathology showed degenerated erythrocytes and ghost cells. Because washout did not provide sustained IOP control, trabeculectomy with mitomycin C and two adjustable scleral-flap sutures was performed. At postoperative month 11 after trabeculectomy, IOP was 10.0 mmHg with a clear anterior chamber. Conclusions and Importance: Delayed blood-reflux-related secondary open-angle glaucoma may occur years after ab-interno goniotomy. These findings indicate that the surgically opened trabecular pathway remains a potential route for retrograde bleeding whenever episcleral venous pressure exceeds intraocular pressure. Clinicians should be mindful of this late phenomenon, which warrants further clinical observation and mechanistic research.

Source: American Journal of Ophthalmology Case Reports

DOI: 10.1016/j.ajoc.2026.102686

Authors: Miao Zhang, Jinfeng Jia, Junwei Tan, Xinbo Gao

Institutions: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, The First People's Hospital of Guangyuan

Language: English

Topic: Glaucoma and retinal disorders

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,590