Surgical treatment for chronic hypotony and anterior proliferative vitreoretinopathy

To determine whether vitreoretinal surgery to release anterior traction in eyes with chronic hypotony and attached posterior retinas increases the intraocular pressure and prevents atrophia bulbi.

In this prospective study, we operated on and followed-up postoperatively 17 eyes of 17 consecutive patients with previous vitreoretinal surgeries for retinal detachments and severe proliferative vitreoretinopathy. These eyes had developed chronic hypotony (intraocular pressure < or = 5 mm Hg for at least one month) and anterior proliferative vitreoretinopathy.

After a minimum of six months of postoperative follow-up (mean, 10.6 months), mean intraocular pressure had increased significantly after surgery from 1.7 to 7.2 mm Hg (P < .001), and ten (59%) of the 17 eyes had a final intraocular pressure greater than 5 mm Hg. Visual acuity did not change significantly after surgery (P = .25). In 13 (76%) of the 17 eyes, visual acuity improved or remained the same. Factors associated with higher postoperative intraocular pressure included hypotony of less than three months' duration (P = .007), preoperative visual acuity of 2/200 or more (P = .02), extent of anterior proliferative vitreoretinopathy of less than 90 degrees (P = .003), absence of tissue over the pars plicata (P = .001), and no anterior reproliferation after surgery (P = .04).

Early surgery to release traction over the anterior retina and uveal tissue in eyes with chronic hypotony and anterior proliferative vitreoretinopathy can increase intraocular pressure and stabilize visual acuity.