Resuturing the scleral flap leads to resolution of hypotony maculopathy.

PURPOSE: We report four eyes of three glaucomatous patients who underwent trabeculectomy using topical mitomycin C. These eyes subsequently developed hypotony maculopathy. Snellen visual acuity decreased to 20/200 or worse in all cases. When the hypotony maculopathy persisted for 6-24 weeks and was unresponsive to nonsurgical therapies, we performed a second surgical procedure consisting of resuturing of the trabeculectomy scleral flap, closing the conjunctiva in its original position. METHODS: The limbal-based conjunctival flap was reopened and the original scleral trabeculectomy flap was located. This flap was resutured to surrounding sclera, presumably limiting filtration. RESULTS: This surgical revision increased the intraocular pressure, reversing the hypotony, and resulted in improved visual acuity to 20/25 or better in all cases with intraocular pressures between 6 and 17 mm Hg without intraocular pressure-lowering medications. The minimum follow-up after revision is 18 months. CONCLUSION: There seems to be a definite relationship between the elevation of intraocular pressure and reversal of the macular damage associated with hypotony maculopathy. The visual outcome we experienced following resuturing of the scleral flap after persistent hypotony appears excellent in the treatment of a complication that is difficult to reverse. This technique has potential and should be strongly considered as a possible therapy in the management of hypotony maculopathy.

Sutureless scleral buckle for retinal detachment with thin sclera.

Retinal detachment surgery can be hazardous in the presence of thin sclera, with increased risk of inadvertent perforation. We designed polymethylmethacrylate belt loops that can be fixed to the sclera with cyanoacrylate tissue adhesive, allowing 360 degrees scleral buckling to be performed without sutures. We report the successful use of this technique in a three-year-old girl with a rhegmatogenous retinal detachment and blue sclerae.

Butterfly-shaped macular dystrophy in four generations.

Four generations in a family were affected by butterfly-shaped macular dystrophy. Affected members ranged in age from 8 to 77 years. In addition to the primary features of autosomal dominant inheritance, bilateral symmetrical pigmented macular lesion, and a low electrooculographic light peak-dark trough ratio, we discovered additional progressive changes: peripapillary and parafoveal chorioretinal atrophy, enlarged blind spots, and paracentral scotomas with diminished visual acuity late. Because of the progressive change in the ophthalmologic appearance of the fundus, the diagnosis could easily be overlooked in advanced cases.