Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Ophthalmology and Therapy
Published in: Ophthalmology and Therapy 2/2015

Open Access 01-12-2015 | Review

Hypotony Maculopathy: Clinical Presentation and Therapeutic Methods

Authors: Merina Thomas, Thasarat S. Vajaranant, Ahmad A. Aref

Published in: Ophthalmology and Therapy | Issue 2/2015

Login to get access

Abstract

Introduction

Hypotony maculopathy is ocular hypotony complicated by papilledema and/or folding of the retina and choroid in the posterior pole. Our objective was to examine the current literature regarding hypotony maculopathy and treatment methods.

Methods

A systematic review of the English-language literature was conducted by performing a broad search of PubMed from 1972 through 2015 using the keywords hypotony maculopathy and hypotony. Additional articles were identified from bibliographies of relevant articles.

Results

Hypotony maculopathy was infrequent before the introduction of antimetabolite agents in glaucoma-filtering surgery, and the incidence of this entity is now up to 20%. Risk factors for developing hypotony maculopathy include male gender, young age, myopia, and primary filtering surgery. Correctly identifying the etiology of hypotony is essential for successful treatment. Treatment of hypotony maculopathy includes procedures to elevate the intraocular pressure, thus reversing the collapse of the scleral wall and chorioretinal wrinkling.

Conclusion

This review discusses the definition, clinical presentation, pathophysiology, incidence and risk factors, prevention and treatment of hypotony maculopathy.
Literature
1.
Pederson JE. Ocular hypotony. In: Ritch R, Krupin T, Shields MB, editors. The glaucomas. 2nd ed. Mosby: St. Louis; 1996. p. 385–95.
2.
Schubert HD. Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous. Surv Ophthalmol. 1996;41:97–125.CrossRefPubMed
3.
Tsai J-C, Chang H-W, Kao C-N, Lai I-C, Teng M-C. Trabeculectomy with mitomycin C versus trabeculectomy alone for juvenile primary open-angle glaucoma. Ophthalmologica. 2003;217:24–30.CrossRefPubMed
4.
Kitazawa Y, Suemori-Matsushita H, Yamamoto T, Kawase K. Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology. 1993;100:1624–8.CrossRefPubMed
5.
Bindlish R, Condon GP, Schlosser JD, D’Antonio J, Lauer KB, Lehrer R. Efficacy and safety of mitomycin-C in primary trabeculectomy: five-year follow-up. Ophthalmology. 2002;109:1336–41 (discussion 1341–1342).CrossRefPubMed
6.
Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, et al. Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120:1268–79.CrossRefPubMed
7.
Ederer F, Gaasterland DA, Dally LG, Kim J, VanVeldhuisen PC, Blackwell B, et al. The Advanced Glaucoma Intervention Study (AGIS): 13. Comparison of treatment outcomes within race: 10-year results. Ophthalmology. 2004;111:651–64.CrossRefPubMed
8.
Gass JDM. Hypotony maculopathy. In: Bellows JC, editor. Contemporary ophthalmology, honoring Sir Steward Duke-Elder. Baltimore: Williams and Wilkins; 1972. p. 343–66.
9.
Kokame GT, de Leon MD, Tanji T. Serous retinal detachment and cystoid macular edema in hypotony maculopathy. Am J Ophthalmol. 2001;131:384–6.CrossRefPubMed
10.
Budenz DL, Schwartz K, Gedde SJ. Occult hypotony maculopathy diagnosed with optical coherence tomography. Arch Ophthalmol. 2005;123:113–4.CrossRefPubMed
11.
12.
Costa VP, Wilson RP, Moster MR, Schmidt CM, Gandham S. Hypotony maculopathy following the use of topical mitomycin C in glaucoma filtration surgery. Ophthalmic Surg. 1993;24:389–94.PubMed
13.
Rasheed el-S null. Initial trabeculectomy with intraoperative mitomycin-C application in primary glaucomas. Ophthalmic Surg Lasers. 1999;30:360–6.
14.
Rulli E, Biagioli E, Riva I, Gambirasio G, De Simone I, Floriani I, et al. Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol. 2013;131:1573–82.CrossRefPubMed
15.
Nuyts RM, Greve EL, Geijssen HC, Langerhorst CT. Treatment of hypotonous maculopathy after trabeculectomy with mitomycin C. Am J Ophthalmol. 1994;118:322–31.CrossRefPubMed
16.
Yun ST, Chua B, Clement CI. Outcomes of chronic hypotony following trabeculectomy. Clin Exp Ophthalmol. 2014;43:485–7.CrossRef
17.
Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B. Loss of visual acuity after trabeculectomy. Ophthalmology. 1993;100:599–612.CrossRefPubMed
18.
Edmunds B, Thompson JR, Salmon JF, Wormald RP. The national survey of trabeculectomy. III. Early and late complications. Eye (Lond). 2002;16:297–303.CrossRef
19.
20.
21.
Kato T, Hayasaka S, Nagaki Y, Matsumoto M. Management of traumatic cyclodialysis cleft associated with ocular hypotony. Ophthalmic Surg Lasers. 1999;30:469–72.PubMed
22.
Toris CB, Pederson JE. Aqueous humor dynamics in experimental iridocyclitis. Investig Ophthalmol Vis Sci. 1987;28:477–81.
23.
Fannin LA, Schiffman JC, Budenz DL. Risk factors for hypotony maculopathy. Ophthalmology. 2003;110:1185–91.CrossRefPubMed
24.
Tran VT, Mermoud A, Herbort CP. Appraisal and management of ocular hypotony and glaucoma associated with uveitis. Int Ophthalmol Clin. 2000;40:175–203.CrossRefPubMed
25.
Mermoud A, Baerveldt G, Minckler DS, Rao NA. [Prostaglandins E2 and F2-alpha in uveitic glaucoma in the Lewis rat]. Klin Monbl Augenheilkd. 1995;206:409–12.CrossRefPubMed
26.
27.
Mietz H, Jacobi PC, Krieglstein GK. Intraoperative episcleral versus postoperative topical application of mitomycin-C for trabeculectomies. Ophthalmology. 2002;109:1343–9.CrossRefPubMed
28.
Suñer IJ, Greenfield DS, Miller MP, Nicolela MT, Palmberg PF. Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology. 1997;104:207–14 (discussion 214–215).CrossRefPubMed
29.
De Fendi LI, Arruda GV, Scott IU, Paula JS. Mitomycin C versus 5-fluorouracil as an adjunctive treatment for trabeculectomy: a meta-analysis of randomized clinical trials. Clin Exp Ophthalmol. 2013;41:798–806.CrossRef
30.
Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL, et al. Three-year follow-up of the tube versus trabeculectomy study. Am J Ophthalmol. 2009;148:670–84.CrossRefPubMed
31.
Budenz DL, Barton K, Gedde SJ, Feuer WJ, Schiffman J, Costa VP, et al. Five-year treatment outcomes in the Ahmed Baerveldt comparison study. Ophthalmology. 2015;122:308–16.CrossRefPubMed
32.
Stamper RL, McMenemy MG, Lieberman MF. Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil. Am J Ophthalmol. 1992;114:544–53.CrossRefPubMed
33.
Jampel HD, Pasquale LR, Dibernardo C. Hypotony maculopathy following trabeculectomy with mitomycin C. Arch Ophthalmol. 1992;110:1049–50.CrossRefPubMed
34.
Uyama M, Takahashi K, Kozaki J, Tagami N, Takada Y, Ohkuma H, et al. Uveal effusion syndrome: clinical features, surgical treatment, histologic examination of the sclera, and pathophysiology. Ophthalmology. 2000;107:441–9.CrossRefPubMed
35.
Palmberg P. Prevention and management of complicated hypotony in trabeculectomy with mitomycin. Highlights Ophthalmol. 1993;21:68–77.
36.
Blok MD, Kok JH, van Mil C, Greve EL, Kijlstra A. Use of the megasoft bandage lens for treatment of complications after trabeculectomy. Am J Ophthalmol. 1990;110:264–8.CrossRefPubMed
37.
Hill RA, Aminlari A, Sassani JW, Michalski M. Use of a symblepharon ring for treatment of over-filtration and leaking blebs after glaucoma filtration surgery. Ophthalmic Surg. 1990;21:707–10.PubMed
38.
39.
Smith MF, Magauran RG, Betchkal J, Doyle JW. Treatment of postfiltration bleb leaks with autologous blood. Ophthalmology. 1995;102:868–71.CrossRefPubMed
40.
Asrani SG, Wilensky JT. Management of bleb leaks after glaucoma filtering surgery. Use of autologous fibrin tissue glue as an alternative. Ophthalmology. 1996;103:294–8.CrossRefPubMed
41.
Palmberg P, Zacchei A. Compression sutures—a new treatment for leaking or painful filtering blebs. IOVS. 1996;37:ARVO Abstract 2032.
42.
Quaranta L, Riva I, Floriani IC. Outcomes of conjunctival compression sutures for hypotony after glaucoma filtering surgery. Eur J Ophthalmol 2013;23:593–6.CrossRefPubMed
43.
Letartre L, Basheikh A, Anctil J-L, Des Marchais B, Goyette A, Kasner OP, et al. Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy. Can J Ophthalmol. 2009;44:567–70.CrossRefPubMed
44.
Chambers M, Baker D. Injection of perfluoropropane gas and viscoelastic as rescue therapy for ocular hypotony following glaucoma filtering surgery. American Glaucoma Society Annual Meeting. 2015 (Abstract).
45.
Friedman SM, Mahootchi A. The use of intravitreal gas for the treatment of ocular hypotony after glaucoma filtration surgery. Ophthalmic Surg Lasers Imaging. 2006;37:234–5.PubMed
46.
Duker JS, Schuman JS. Successful surgical treatment of hypotony maculopathy following trabeculectomy with topical mitomycin C. Ophthalmic Surg. 1994;25:463–5.PubMed
Metadata
Title
Hypotony Maculopathy: Clinical Presentation and Therapeutic Methods
Authors
Merina Thomas
Thasarat S. Vajaranant
Ahmad A. Aref
Publication date
01-12-2015
Publisher
Springer Healthcare
Published in
Ophthalmology and Therapy / Issue 2/2015
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI
https://doi.org/10.1007/s40123-015-0037-z

Other articles of this Issue 2/2015

Ophthalmology and Therapy 2/2015 Go to the issue

Review

Lasik Xtra® Provides Corneal Stability and Improved Outcomes

Case Report

Rosacea Blepharoconjunctivitis Treated with a Novel Preparation of Dilute Povidone Iodine and Dimethylsulfoxide: a Case Report and Review of the Literature

Case Report

Pressure-Lowering Effect of Fistula Occlusion in a Patient with Secondary Glaucoma Due to an Intracranial Arteriovenous Fistula

Original Research

Improved Surgical Success of Combined Glaucoma Tube Shunt and Retisert® Implantation in Uveitic Eyes: A Retrospective Study

Case Report

A Novel Technique for Repositioning of a Migrated ILUVIEN® (Fluocinolone Acetonide) Implant into the Anterior Chamber

Review

The Future of Dry Eye Treatment: A Glance into the Therapeutic Pipeline
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits