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Victoria L Tseng, Anne L Coleman, Pablo Romero, Fei Yu, Kenneth W Robertson-Brown, Joseph Caprioli; Hypotony Maculopathy after Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2950.
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© 2017 Association for Research in Vision and Ophthalmology.
To identify factors associated with hypotony maculopathy after trabeculectomy.
A case control study was performed of glaucoma patients at the Stein Eye Institute who had trabeculectomy between 1990 and 2014. Cases included eyes with postoperative hypotony maculopathy, and controls included eyes with postoperative numerical hypotony without maculopathy, defined as intraocular pressure (IOP) ≤5 mmHg on 2 or more consecutive visits 6 weeks or later after surgery. Preoperative characteristics that were evaluated included demographics, glaucoma type, systemic comorbidities, history of previous trabeculectomy, lens status, family history of glaucoma, number of glaucoma medications, IOP, visual acuity, visual field mean deviation (MD), number of sutures in the scleral flap, postoperative laser suture lysis, and surgeon. Cox proportional hazards regression was performed to assess the association between each preoperative characteristic and time to hypotony maculopathy.
The study population included 32 cases and 152 controls. The majority of the population was diagnosed with primary open angle glaucoma (n=99; 53.8%). Mean preoperative IOP was 17.9±7.0 mmHg (range 5.0-51.0 mmHg), and average MD was -11.9±7.9 dB (range -31.4 to 2.8 dB). Mean IOP at the time of hypotony maculopathy was 4.1±2.9 mmHg (range 0.0-14.0 mmHg). There were 7/32 eyes (21.9%) with IOP >5 mmHg at the time of maculopathy. All of these eyes had numerical hypotony prior to maculopathy, with a mean duration between numerical hypotony and hypotony maculopathy of 453.7±618.7 days, versus 990.0±842.8 days in eyes with IOP ≤5 mmHg at the time of hypotony maculopathy (p=0.23). Significant adjusted risk factors hypotony maculopathy included number of medications (hazards ratio [HR]=0.39, 95% confidence interval [CI]=0.18, 0.85 for ≥3 medications vs. <3 medications) and number of sutures (HR=0.11, 95% CI=0.03, 0.50 for 3 vs. 2 sutures).
Potential factors associated with maculopathy after trabeculectomy include number of medications prior to surgery and number of sutures on the scleral flap. Having IOP >5 mmHg at the time of maculopathy is potentially associated with shorter mean duration between numerical hypotony and hypotony maculopathy. We recommend further studies of the relationship between hypotony maculopathy and posteropative IOP fluctuations and trends to gain insight for clinical practice and prevention efforts.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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