Resuturing the Scleral Flap Leads to Resolution of Hypotony Maculopathy

Abstract

We report four eyes of three glaucomatous patients who underwent trabeculectomy using topical mitomycin C. These eyes subsequently developed hypotony maculopathy. Snellen visual acuity decreased to 20/200 or worse in all cases. When the hypotony maculopathy persisted for 6-24 weeks and was unresponsive to nonsurgical therapies, we performed a second surgical procedure consisting of resuturing of the trabeculectomy scleral flap, closing the conjunctiva in its original position. The limbal-based conjunctival flap was reopened and the original scleral trabeculectomy flap was located. This flap was resutured to surrounding sclera, presumably limiting filtration. This surgical revision increased the intraocular pressure, reversing the hypotony, and resulted in improved visual acuity to 20/25 or better in all cases with intraocular pressures between 6 and 17 mm Hg without intraocular pressure-lowering medications. The minimum follow-up after revision is 18 months. There seems to be a definite relationship between the elevation of intraocular pressure and reversal of the macular damage associated with hypotony maculopathy. The visual outcome we experienced following resuturing of the scleral flap after persistent hypotony appears excellent in the treatment of a complication that is difficult to reverse. This technique has potential and should be strongly considered as a possible therapy in the management of hypotony maculopathy.