Supplementary Material for: Anterior Chamber Sulfur Hexafluoride (SF6) Injection for Hypotony Management: Case Report and Literature Review

Introduction: Hypotony is a potentially vision-threatening condition that may persist despite conservative management, often necessitating surgical or interventional treatment. We present a case where a minimally invasive injection of 100% sulfur hexafluoride (SF6) into the anterior chamber (AC) successfully reversed refractory hypotony secondary to ciliary body shut-down.
Case Presentation: A 72-year-old male with advanced pseudoexfoliation glaucoma and a nonfunctioning trabeculectomy presented with hypotony, decreased vision, a deep AC, and 360° serous choroidal effusions. After excluding other etiologies, ciliary body shutdown was presumed. Conventional measures, including topical steroids, cycloplegia, and AC viscoelastic injection, failed to restore intraocular pressure (IOP). Given the refractory course, 100% SF6 gas was injected into the AC. Within 24 hours, a reverse pupillary block developed, leading to a rapid IOP increase. The gas fully reabsorbed within weeks, with resolution of the choroidal effusions and normalization of IOP. At six months, the patient maintained stable IOP and visual acuity without further intervention.
Conclusion: This case highlights the potential of SF6 gas injection as a minimally invasive and effective treatment for refractory hypotony, even when the underlying mechanism is not over-filtration.