Novel therapeutic strategies to restore vision in ocular hypotony (STRETCH): results from a prospective pilot series

To report visual and anatomical outcomes following intravitreal hydroxypropylmethylcellulose (HPMC) for the treatment of chronic structural hypotony.

This study is a prospective interventional case series. Eight patients with chronic structural hypotony for more than 3 months, defined by an intraocular pressure (IOP) of <6.5 mm Hg. All patients had evidence of visual potential, clear cornea and a clear visual axis.Patients received multiple intravitreal HPMC injections (70 µL-1400 µL), administered every 2-4 weeks until either pre-morbid axial length was achieved, an IOP of 10-15 mm Hg was sustained for 4 weeks without signs of hypotony, or axial length of the contralateral eye was reached. They were followed up for 12 months after the first intravitreal injection.

Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (LogMAR) improved in 87.5% of eyes, with one eye remaining stable. The initial BCVA range was 0.3-1.7 LogMAR, and the final range was 0.1-1.6 LogMAR. IOP increased in 87.5% of eyes, from an initial range of 1-5 mm Hg to 3-23 mm Hg. Axial length increased in 75% of eyes, with a median increase of 1 mm (range 0.6-2.9 mm).Two adverse events occurred: uveitis flare-ups leading to loss of HPMC clarity in two eyes, managed with topical and intravitreal steroids, and two cases of temporary vision loss post-injection, resolved after paracentesis.

This is the first case series to use a structured protocol for intravitreal HPMC in chronic hypotony management. The treatment improved vision and restored ocular anatomy, showing promise for managing structural hypotony in eyes with visual potential.