Post-vitrectomy hypotony: mechanisms, risk factors and management strategies

Ocular hypotony remains a clinically significant complication following vitreoretinal surgery, particularly in complex retinal detachment repair, repeat vitreoretinal surgery, and silicone oil removal. This review aims to synthesize current evidence regarding the mechanisms, risk factors, clinical consequences, and management strategies of post-vitrectomy hypotony.

This narrative review provides a qualitative synthesis of recent literature focusing on mechanisms, risk factors, clinical consequences, and management of post-vitrectomy hypotony.

Consistent evidence identifies silicone oil removal, absence of intraocular tamponade, long axial length, repeat vitreoretinal surgery, anterior proliferative vitreoretinopathy, and preoperative intraocular pressure asymmetry as major risk factors. While early postoperative hypotony following small-gauge vitrectomy is typically transient and self-limiting, persistent hypotony represents a clinically significant condition associated with progressive structural damage, including hypotony maculopathy, choroidal folds, outer retinal injury and, in advanced cases, phthisis bulbi.

Post-vitrectomy hypotony should be considered a multifactorial and dynamic process rather than a single-complication entity. A mechanism-based, individualized management strategy combined with meticulous surgical technique and early recognition of persistent hypotony is essential to optimize long-term visual outcomes.