Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment.
OBJECTIVE
Hypotony maculopathy after glaucoma filtering surgery with adjunctive mitomycin C has been reported to occur in 3% to 14% of cases. The authors evaluated its incidence when using a corneal safety-valve incisior intended to reduce its occurrence. The authors also evaluated a technique for reversing hypotony maculopathy by reoperation using two sets of stitches in the scleral flap, with one set tied tightly to temporarily raise the intraocular pressure, stretch the sclera, and flatten chorioretinal folds.


METHODS
The authors reviewed the results of 699 procedures performed between April 1991 and October 1994. All were performed or supervised by one surgeon (PFP).


RESULTS
Hypotony maculopathy developed in 9 (1.3%) of 699 eyes. There was a statistically significant higher incidence in primary filters (4%) as compared to secondary filters or combined procedures. After revision, eight (89%) of nine recovered visual acuity of greater than or equal to 20/30 and the mean intraocular pressure was 14.5 +/- 4 mmHg at a mean follow-up of 15 months.


CONCLUSIONS
The incidence of hypotony maculopathy after glaucoma filtering surgery with mitomycin C using a corneal safety-valve incision is less than that reported in the literature without this incision. There is an increased risk in myopes, young patients, and primary filters. Early intervention with the described scleral flap revision technique usually allows restoration of prefiltration visual acuity without compromise of bleb function.
Suñer
I J
IJ
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL 33101-6880, USA.
Greenfield
D S
DS
Miller
M P
MP
Nicolela
M T
MT
Palmberg
P F
PF
D000328:Adult; D000368:Aged; D002387:Cataract Extraction; D017024:Chemotherapy, Adjuvant; D003315:Cornea / Q000601:surgery; D005260:Female; D018463:Filtering Surgery / Q000009:adverse effects*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007429:Intraocular Pressure; D008266:Macula Lutea; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000009:adverse effects*; D019384:Nucleic Acid Synthesis Inhibitors / Q000009:adverse effects*; D015814:Ocular Hypotension / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D012164:Retinal Diseases / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D012307:Risk Factors; D012590:Sclera / Q000601:surgery; D013524:Surgical Flaps; D014792:Visual Acuity
D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin