title: The surgical management of hypotony.
abstract: OBJECTIVE
  To study the effect of dissecting epiciliary proliferative tissue in eyes that are hypotonous.
  
  
  METHODS
  Retrospective noncomparative case series.
  
  
  METHODS
  Eight patients (nine eyes).
  
  
  METHODS
  Normalization of intraocular pressure and preservation of vision.
  
  
  METHODS
  A chart review was conducted to locate all surgical procedures performed primarily for hypotony. Nine procedures on eight eyes of eight patients seen in the vitreoretinal service of the Wilmer Ophthalmological Institute were identified and included in this study. Six of these eyes had undergone prior surgery for retinal detachment in association with proliferative vitreoretinopathy, one had undergone surgery for retinal detachment in the setting of a ruptured globe, and two had undergone cataract surgery and coined the diagnoses of uveitis (juvenile rheumatoid arthritis and sarcoid). Dissection and removal of the epiciliary proliferative tissue and lens capsule was undertaken by two surgeons (EdJ and MSH) using either a pars plana or limbal approach. The main outcome measures were intraocular pressure (IOP) and visual acuity after an average follow-up of 26 months (range, 9-48 months).
  
  
  RESULTS
  In the immediate postoperative period, all patients showed an increase in IOP (average increase of 6.3 mm Hg; range, 3-14 mmHg). This average increase in IOP decreased to 5.2 mmHg at 6 months and 4.2 mm Hg at 12 or more months of follow-up. The rate of the IOP decrease appeared to lessen with time, suggesting long-term stabilization. Visual acuity remained stable in all patients, although the final level of vision was low.
  
  
  CONCLUSIONS
  Surgical intervention for hypotony with greater than 1 year follow-up continues to show elevated IOP in some patients, despite the fact that the large initial increase in IOP is not sustained. No eye had phthisis develop or became painful. However, no eye had marked improvement in vision. Further study is needed to uncover the main contributing factors that result in hypotony before IOP can be maintained for prolonged periods in more hypotonous eyes and before these eyes can regain more vision.
authors.affiliation: The Vitreoretinal Service, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: S R
authors.initials: SR
authors.lastname: O'Connell
authors.forename: A B
authors.initials: AB
authors.lastname: Majji
authors.forename: M S
authors.initials: MS
authors.lastname: Humayun
authors.forename: E
authors.initials: E
authors.lastname: de Juan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction; D002924:Ciliary Body / Q000601:surgery*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D007903:Lens Capsule, Crystalline / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015814:Ocular Hypotension / Q000601:surgery*; D012163:Retinal Detachment / Q000601:surgery; D012189:Retrospective Studies; D014792:Visual Acuity; D018630:Vitreoretinopathy, Proliferative / Q000601:surgery