MACULAR OUTER RETINAL ATROPHY AFTER VITRECTOMY AND HYPOTONY: TWO CASES

To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy.

Retrospective chart review of two patients' records between 2019 and 2023.

Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week postoperatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the intraocular lens dislocated and was exchanged with scleral fixation of a new intraocular lens. On postoperative Day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on postoperative Day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable for years but resulted in reduced central vision.

Hypotony after vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.