RESUTURING THE SCLERAL FLAP LEADS TO RESOLUTION OF HYPOTONY MACULOPATHY

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.