Background
A serious complication following trabeculectomy with mitomycin C (MMC) is intraocular hypotony with hypotony maculopathy,
papilledema, flattening of the anterior chamber, corneal decompensation and a decrease in visual acuity. We describe a new
simple surgical technique for the treatment of hypotony maculopathy following trabeculectomy with MMC.
Methods
In a prospective consecutive case study, 16 patients with hypotony maculopathy following trabeculectomy with MMC were included.
Through the intact conjunctiva, additional 10.0 nylon sutures were placed through the scleral flaps into the adjacent sclera.
Assessment of visual acuity, intraocular pressure (IOP) measurement and fundoscopy were performed on the 1st and 7th day postoperatively
and 1, 3 and 6 months postoperatively. Photography of the bleb and the posterior pole and optical coherence tomography imaging
of the posterior pole were performed.
Results
Before surgery (flap suture), the mean IOP was 2.8 mmHg (±1.1; range from 1 to 4 mmHg). It was 24.9 ± 11.7 mmHg (range; 9–48 mmHg)
on the 1st postoperative day, 15.7 ±8.1 mmHg (range; 5–35 mmHg) on day 7, 11.1 ±4.1 mmHg (range; 5–20 mmHg) 1 month after
surgery, 9.3 ±3.9 mmHg (range; 2–20 mmHg) after 3 months, and 9.6 ±4.2 mmHg (range; 2–20 mmHg) after 6 months. The best corrected
mean visual acuity was 20/50 before trabeculectomy and 20/160 before flap suture. It improved to 20/63 at 6 months postoperatively.
Clinical signs of hypotony maculopathy disappeared in all patients. No bleb leakage was observed in any patient during follow-up.
Conclusion
Resuturing the scleral flap through the intact conjunctiva is an effective and minimally invasive method to treat hypotony
maculopathy following trabeculectomy with MMC. Thus, opening the conjunctiva can be avoided.
Keywords Glaucoma surgery - Trabeculectomy - Hypotony maculopathy - Management - Low intraocular pressure
The authors have no financial interest in the subject of this paper.