Abstract
Abstract: :
Purpose:To evaluate the use of Healon®5 in post–operative hypotony patients with glaucoma. Methods:Between June 2002 and April 2003, we prospectively recruited 15 consecutive glaucoma patients with post–operative hypotony that persisted for seven days or more. An intracameral injection of 2.3% sodium hyaluronate (Healon®5) was administered either at the slit lamp (sterile conditions) or under the microscope in the operating room. Pre–Healon®5 visual acuity and IOP measurements were compared to the 1–2 week and 4–6 week post–Healon®5 readings. The relationship between onset of hypotony to visual acuity, IOP outcomes, and complications were analyzed. Results:Baseline IOP before Healon®5 injection ranged from 0 to 6 mmHg, with a mean of 3.8 ±1.58 mmHg. The mean 1–2 week and 4–6 week IOP readings were 6.58±2.62 and 6.50 ±2.24 mmHg, respectively. There was a statistically significant increase in IOP at both follow–up periods (p<0.01). Mean baseline, week 1–2 and week 4–6 logMar visual acuity readings were 0.91 ±0.71; 0.74±0.64 and 0.70±0.49, respectively. Neither follow–up VA score was significantly different from baseline (p=0.21 and p=0.16). There were 6 cases (40%) of hypotony that started within 3 months of the initial surgery, while the remaining 9 cases (60%) of hypotony began after 3 months. In the early hypotony cases, IOP increased significantly at both follow–ups from baseline (p<0.05), but VA did not improve significantly. Among the late hypotony cases, we found that there was no change from baseline on either VA or IOP. Chorioretinal and retinal folds that were present in four eyes before Healon®5 injection had improved or resolved by the 4–6 week follow–up period. Conclusions:Injection of Healon®5 raises IOP in post–operative hypotony cases. However, the increase is not clinically significant since the benefit was not sustained, and IOP did not elevate sufficiently to positively impact the clinical course. The IOP increase was greater among the early onset hypotony cases rather than late onset ones. Physicians may consider using Healon®5 intracamerally to treat post–operative hypotony, but in conjunction with other more established treatments, since used alone, the clinical course did not significantly improve.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • vitreous substitutes • injection