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Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment
I J Suñer1, D S Greenfield, M P Miller
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33101-6880, USA.
Purpose:
Hypotony maculopathy after glaucoma filtering surgery with adjunctive mitomycin C has been reported to occur in 3% to 14% of cases. The authors evaluated its incidence when using a corneal safety-valve incisior intended to reduce its occurrence. The authors also evaluated a technique for reversing hypotony maculopathy by reoperation using two sets of stitches in the scleral flap, with one set tied tightly to temporarily raise the intraocular pressure, stretch the sclera, and flatten chorioretinal folds.
Methods:
The authors reviewed the results of 699 procedures performed between April 1991 and October 1994. All were performed or supervised by one surgeon (PFP).
Results:
Hypotony maculopathy developed in 9 (1.3%) of 699 eyes. There was a statistically significant higher incidence in primary filters (4%) as compared to secondary filters or combined procedures. After revision, eight (89%) of nine recovered visual acuity of greater than or equal to 20/30 and the mean intraocular pressure was 14.5 +/- 4 mmHg at a mean follow-up of 15 months.
Conclusion:
The incidence of hypotony maculopathy after glaucoma filtering surgery with mitomycin C using a corneal safety-valve incision is less than that reported in the literature without this incision. There is an increased risk in myopes, young patients, and primary filters. Early intervention with the described scleral flap revision technique usually allows restoration of prefiltration visual acuity without compromise of bleb function.
Insights
Hypotony maculopathy after glaucoma surgery is reduced with a corneal safety-valve incision. Reoperation using a specific scleral flap technique effectively restores vision in most cases.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Macular Edema
Background:
- Hypotony maculopathy is a known complication of glaucoma filtering surgery with mitomycin C.
- Incidence rates range from 3% to 14% in existing literature.
- A corneal safety-valve incision was developed to mitigate this risk.
Purpose of the Study:
- To evaluate the incidence of hypotony maculopathy using a corneal safety-valve incision.
- To assess a surgical technique for reversing hypotony maculopathy.
Main Methods:
- Retrospective review of 699 glaucoma filtering procedures.
- Procedures performed or supervised by a single surgeon between April 1991 and October 1994.
- Evaluation of a scleral flap revision technique involving specific stitch placement.
Main Results:
- Hypotony maculopathy occurred in 1.3% (9/699) of eyes.
- Higher incidence observed in primary filters (4%) compared to secondary or combined procedures.
- Eight of nine affected eyes (89%) recovered visual acuity ≥20/30 after revision, with a mean intraocular pressure of 14.5 ± 4 mmHg.
Conclusions:
- Corneal safety-valve incisions appear to reduce hypotony maculopathy incidence post-glaucoma surgery.
- Myopes, young patients, and primary filters face increased risk.
- Early scleral flap revision effectively restores visual acuity without compromising bleb function.