June 2015
Volume 56, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2015
Hypotony maculopathy after trabeculectomy: outcomes of bleb revision and choroidal drainage
Author Affiliations & Notes
  • Cheng Zhou
    University of Minnesota Medical School, Saint Paul, MN
  • Elena Bitrian
    Ophthalmology, University of Minnesota, Minneapolis, MN
  • Martha M Wright
    Ophthalmology, University of Minnesota, Minneapolis, MN
  • Alana L Grajewski
    Ophthalmology, Bascom Palmer Eye Institute, Miami, FL
  • Footnotes
    Commercial Relationships Cheng Zhou, None; Elena Bitrian, None; Martha Wright, None; Alana Grajewski, Alcon (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2015, Vol.56, 2736. doi:
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      Cheng Zhou, Elena Bitrian, Martha M Wright, Alana L Grajewski; Hypotony maculopathy after trabeculectomy: outcomes of bleb revision and choroidal drainage. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2736.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To describe the visual acuity (VA) outcomes and intraocular pressure (IOP) outcomes after bleb revision and choroidal drainage for hypotony maculopathy.

Methods: This is a retrospective chart review of patients with hypotony maculopathy after trabeculectomy that underwent a bleb revision between June 2006 and December 2012 at a single academic institution. Hypotony maculopathy was defined by low IOP, loss in visual acuity, retinal striae, and macular edema. Only patients with more than 3 months of follow-up after bleb revision were included. Surgery involved resection of thin or leaky conjunctiva, resuturing of the scleral flap with 10-0 nylon and conjunctival mobilization and advancement. Five cases had additionally choroidal drainage surgery during the same procedure.

Results: Twenty eight eyes of 28 patients with age 61.15 ± 12.08 years (range 28.56-79.95 years) were followed for an average of 1.83 ± 2.01 years (range 3 months -6.67 years). Sixteen (57%) were female, 5 (17.86%) presented with ophthalmoscopically visible choroidal detachments and 100% had macula striae. After bleb revision, the mean baseline intraocular pressure (IOP) increased from 3.12 ± 1.88 mmHg to 11.22 ± 5.33 mmHg at 3 months of follow-up (P<0.001) and12.15± 6.08 mmHg at final follow-up (p<0.001) . Visual acuity also improved from 0.22 ± 0.19 before bleb revision to 0.39 ± 0.29 at 3 months after bleb revision (P<0.001) and 0.43 ± 0.30 at final follow-up (P<0.001). Visual potential was very limited in 4 patients due to advanced glaucoma before hypotony. Three cases (10.7 %) required a second bleb revision to resolve the hypotonous maculopathy. Two patients (7.14%) needed glaucoma drops at the final follow-up while the rest of patients had adequate IOP control without need of glaucoma medications.

Conclusions: Surgical repair for hypotony maculopathy was associated with improvement in IOP and VA, both at short and long term of follow-up. Bleb revision is an effective procedure with good long-term control of IOP and improvement of visual acuity in eyes with hypotonous maculopathy.

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