A Case of Traumatic Hypotony Maculopathy Treated by Intravitreal Air Injection

PURPOSE: To report a case of traumatic hypotony maculopathy treated by intravitreal air injection. CASE SUMMARY: A 20-year-old female presented with decreased visual acuity in the left eye 2 days after trauma. Best corrected visual acuity (BCVA) was 0.5 and the intraocular pressure (IOP) was 5 mm Hg. Indirect ophthalmoscopy revealed chorioretinal folds in the macular area. Gonioscopy showed angle recession from 4 to 7 o'clock. Initially, pressure patching and conservative management were performed on the left eye 10 days after examination. However, deterioration of the chorioretinal fold was observed without any change in IOP. Finally, intravitreal air injection (0.5 cc) was performed 10 days after the start of conservative treatments. Following air injection, the normalization of IOP and gradual reduction of chorioretinal fold was observed. BCVA improved to 1.0 and IOP was maintained between 12 and 14 mm Hg for 24 months after the air injection. CONCLUSIONS: Intravitreal air injection may safely and effectively treat traumatic hypotony maculopathy.

Cyclocryotherapy and Intravitreal Gas Tamponade of a Chronic Cyclodialysis Cleft: Case Report

PURPOSE: To report a case of chronic hypotony maculopathy caused by traumatic cyclodialysis cleft and treated with 20% sulfur hexafluoride (SF6) gas tamponade with cyclocryotherapy. CASE SUMMARY: A 39-year-old woman with a history of blunt trauma developed a unilateral chronic ocular hypotony in her left eye. She was treated with topical atropine sulphate 1% for 2 months. Three years later, she was referred to our clinic for evaluation and treatment of persistent hypotony. The intraocular pressure (IOP) was 4 mm Hg and the best corrected visual acuity was 0.4. B-scan echography revealed a choroidal effusion and fundus examination showed choroidal detachment and macular folds. Gonioscopy examination revealed cyclodialysis cleft from the direction of 7 o'clock to 11 o'clock. A single bubble of SF6 20% (0.4 cc) was injected into the vitreous cavity and transconjunctival cyclocryotherapy was performed under retrobulbar anesthesia. Six months later, the IOP was 12 mm Hg and the best corrected visual acuity was 1.0. B-scan echograpy and fundus examination showed the disappearance of the choroidal effusion. CONCLUSIONS: Gas tamponade with cyclocryotherapy may be useful in cases of cyclodialysis cleft that failed to respond to medical therapy.

Treatment of Hypotony Maculopathy Caused by Traumatic Cyclodialysis with Vitrectomy, Gas Tamponade, and Cryotherapy

PURPOSE: To report a case of hypotony maculopathy caused by traumatic cyclodialysis and treated by vitrectomy combined with gas tamponade and cryotherapy. METHODS: A 35-year-old man with hypotony maculopathy caused by traumatic cyclodialysis was unsuccessfully treated with conservative medical therapy, laser photocoagulation, and direct cyclopexy. The intraocular pressure (IOP) was 2 mm Hg and the vision was counting finger with chorioretinal folds. Vitrectomy combined with gas tamponade and cryotherapy was performed without lens surgery 5 months after trauma. RESULTS: After vitrectomy, fundus photograph and optical coherence tomography revealed complete loss of preoperative chorioretinal folds. The visual acuity improved to 0.3 and IOP was maintained within a normal range during the 24 month follow-up. CONCLUSIONS: This case shows that vitrectomy combined with gas tamponade and cryotherapy is effective for the treatment of traumatic cyclodialysis with persistent hypotony, probably without lens surgery.

Treatment for Persistent Hypotony due to Cyclodialysis

We assessed 14 eyes of 14 patients with persisting hypotony due to cyclodialysis by blunt trauma of after secondary intraocular lens implantation. All the 14 eyes showed persistent hypotony and no increment of intraocular pressure(IOP) nor the visual acuity during the follow up period of average 4.6 months before treatment, We treated these eyes with argon laser photocoagulation and/or direct cyclopexy. After treatment, the IOP changed from 3.7+/-1.5mmHg to 13.7+/-5.1mmHg, and posttreatment IOP was greater than 8mmHg in 12 eyes. All 14 eyes showed visual acuity under 0.3 before the treatment and after treatment, the visual acuity improved by 4.2+/-3.3 lines at the last follow up visit. The follow up period was 12.5 months on average. Before treatment, all the 12 eyes that had no medial opacity showed hypotony maculopathy, but after treatment only 4 eyes showed persisting hypotony maculopathy. A-scan axial length measurement was performed on 8 eyes before and after treatment, and the axial lengths were increased by 0.90+/-0.88mm after treatment in 7 eyes in which IOP were increased. The change in refractive errors before and after treatment was possible to be assessed in 9 eyes and among them, 7 eyes showed increment of IOP. Among those 7 eyes, 2 eyes had shallow chambers with anteriorly displaced lens before treatment and showed repositioning of lenses and hyperopic shift by +2.86 Dsph on average after treatment, but the remaining 4 eyes excluding one eye that received lensectomy at the time of surgery for taumatic cataract, showed myopic shift by -2.31 Dsph on average after treatment.

Hypotony After Trabeculectomy with Mitomycin C

The purpose of this study is to evaluate the influence of clinical factors on the development of postoperative hypotony, and also to determine whether the occurrence of hypotony has any effect on the outcome of trabeculectomy with intraoperative mitomycin C. The authors retrospectively reviewed the outcome in 160 eyes of 112 patients who underwent tight scleral flap trabeculectomy with releasable sutures. Mitomycin C with 0.25 or 0.5mg/ml was applied for 3 or 5 minutes between the Tenon's capsule and the sclera. The mean follow-up period was 16.5 +/- 11.5 months. Success of the trabeculectomy was defined as intraocular pressure (IOP) 6-21 mmHg with or without medications. Hypotony(IOP

Efficacy and Safety of Mitomycin C Trabeculectomy in Patients with Uncomplicated Glaucoma Compared with Refractory Glaucoma

The efficacy and safety of mitomycin C(MMC) trabeculectomy was tested in patients with uncomplicated glaucoma(low-risk group) and the result was compared with that in patients with refractory glaucoma(high-risk group). Subjects included 37 eyes of 26 consecutive patients in low-risk group and 36 eyes of 26 patients in high-risk group. The mean preoperative IOP was 32.9 +/- 9.7 mmHg and 31.9 +/- 8.7 mmHg, respectively(p=1.45). The mean number of preoperative medications was 2.8 +/- 0.8 and 2.0 +/- 0.9, respectively(p<0.05). MMC(0.25 mg/ml or 0.5 mg/ml) was applied between Tenon's capsule and the sclera during trabeculectomy for 3 minutes in low-risk group, for 5 minutes in high-risk group. Scleral-flap was closed with tight releasable sutures. Eyes followed longer than 3 months were included(mean of 14.1 +/- 8.0 months vs 11.9 +/- 6.8 months, p=0.23). The low-risk group had better postoperative results including: a lower IOP at last follow-up(13.7 +/- 3.2 vs 17.2 +/- 8.4 mmHg, p=0.02), a better success rate(94% vs 83% with or without medications, p=0.23: 83% vs 55% without medications, p=0.02), a lower postoperative need for glaucoma medications(0.2 +/- 0.4 vs 0.6 +/- 08, p=0.005). Overall complications were similar between both groups. One of 37 eyes(3%) in the low-risk group developed a hypotony(p=0.51) and one of 36 eyes(3%) in the high-risk group developed a hypotony maculopathy(p=0.49). This study suggests that MMC trabeculectomy with tight releasable scleralflap sutures is safe and effective in controlling IOP not only in refractory glaucoma but also, more successfully, in uncomplicated glaucoma.

Spontaneous Resolution of Mitomycin C Trabeculectomy Associated Hypotony Maculopathy

Prolonged hypotony and related complications can occur after trabeculectomy, especially with adjunctive mitomycin C. Prolonged hypotony can produce a permanent reduction in vision. A 22-year-old woman with primary open-angle glaucoma underwent uncomplicated trabeculectomy. A sponge soaked with a 0.5mg/ml solution of mitomycin C was placed between the conjunctiva and the scleral flap for 5 minutes. Two weeks after surgery, visual acuity was reduced to 20/400 and intraocular pressure was 3mmHg. There were disc edema, vascular tortuosity, and radiating chorioretinal folds in the macular area. The bleb was pale, highly elevated, and extended for 270 degrees of the limbus. The anterior chamber was formed, and no bleb leak, cyclodialysis cleft, choroidal detachment were seen. Her intraocular pressure was 2-7mmHg during the 12 weeks after surgery. At the last examination, visual acuity improved at the preoperative level of 20/30 and intraocular pressure was 10mmHg. Fortunately, hypotony maculopathy had improved without any specific management.