Purpose: We report four eyes of three glaucomatous patients who underw
ent trabeculectomy using topical mitomycin C. These eyes subsequently
developed hypotony maculopathy. Snellen visual acuity decreased to 20/
200 or worst in all cases. When the hypotony maculopathy persisted for
6-24 weeks and was unresponsive to nonsurgical therapies, we performe
d a second surgical procedure consisting of resuturing of the trabecul
ectomy scleral flap, closing the conjunctiva in its original position.
Methods: The limbal-based conjunctival flap was reopened and the orig
inal scleral trabeculectomy nap was located. This nap was resutured to
surrounding sclera, presumably limiting filtration. Results: This sur
gical revision increased the intraocular pressure, reversing the hypot
ony, and resulted in improved visual acuity to 20/25 or better in all
cases with intraocular pressures between 6 and 17 mm Hg without intrao
cular pressure-lowering medications. The minimum follow-up after revis
ion is 18 months. Conclusion: There seems to be a definite relationshi
p between the elevation of intraocular pressure and reversal of the ma
cular damage associated with hypotony maculopathy. The visual outcome
we experienced following resuturing of the scleral flap after persiste
nt hypotony appears excellent in the treatment of a complication that
is difficult to reverse. This technique has potential and should be st
rongly considered as a possible therapy in the management of hypotony
maculopathy.