Scleral patch as a definitive treatment for hypotonic maculopathy after trabeculectomy

Neilzo Nunes Oliveira,Isadora Oliveira Jeha,Leonardo Bittencourt Silveira,João Antonio Prata Junior

doi:10.5935/0034-7280.20160032

Abstract

A female patient with juvenile glaucoma without clinical control underwent a trabeculectomy with mitomycin C, and developed eye hypotension which did not respond to conservative treatment, with subsequent hypotonic maculopathy. The patient was treated using a scleral patch provided by a donor above the fistula, which improved intraocular pressure and visual acuity. The use of the scleral patch above the fistula seems an adequate therapy to treat ocular hypotension due to the over-filtering trabeculectomy bubble. The surgeon should consider this technique when planning surgical solutions for such cases.

Highlights

One of the postoperative complications of trabeculectomy is the occurrence of eye hypotonia, which can be caused by: increasing the flow of aqueous humor (AH) as in cases of hyperfunctioning bubble; conjunctival leakage of AH; reducing the production of AH resulting from ciliocoroidal detachment or some inflammatory process[1,2].Extended hypotension can result in the development of hypotonic maculopathy, characterized by low visual acuity (LVA), and characteristic signs in the eye fundus examination, as retinal streaks, coroidal effusion, and papilla edema.[1,2,3]
A female patient with juvenile glaucoma without clinical control underwent a trabeculectomy with mitomycin C, and developed eye hypotension which did not respond to conservative treatment, with subsequent hypotonic maculopathy
La Borwit et al reported the results of the reduction and repair of the blister.[4]. Cronemberger et al described the resection of the hyperfunctioning bubble.[5]. Leen et al, and Wise et al, in turn, have analyzed the autologous blood injection for correcting hyperfiltration.[6,7] Grady et al described the use of tissue adhesive.[8]. Gomes et al studied the use of amniotic membrane for such purpose[9]

Summary

Introduction

One of the postoperative complications of trabeculectomy is the occurrence of eye hypotonia (intraocular pressure less than 6 mmHg), which can be caused by: increasing the flow of aqueous humor (AH) as in cases of hyperfunctioning bubble; conjunctival leakage of AH (positive Seidel); reducing the production of AH resulting from ciliocoroidal detachment or some inflammatory process[1,2].Extended hypotension can result in the development of hypotonic maculopathy, characterized by low visual acuity (LVA), and characteristic signs in the eye fundus examination, as retinal streaks, coroidal effusion, and papilla edema.[1,2,3]. One of the postoperative complications of trabeculectomy is the occurrence of eye hypotonia (intraocular pressure less than 6 mmHg), which can be caused by: increasing the flow of aqueous humor (AH) as in cases of hyperfunctioning bubble; conjunctival leakage of AH (positive Seidel); reducing the production of AH resulting from ciliocoroidal detachment or some inflammatory process[1,2]. The use of antiproliferative medication in the filtering surgeries such as 5fluorouracil and mitomycin C greatly increased the incidence of these complications[2]. There are studies reporting 20% of hypotonia incidence in eyes with intraoperative exposure to mitomycin C (0.54 mg per ml) for 3.5 minutes, and 35.7% in longer periods.[2]. There are reports proposing different solutions to cases of maculopathy associated to bubble hyperfunction. Ventura et al described the use of compression suture[10]

Objectives

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Conclusion