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