HYPOTONY MACULOPATHY FOLLOWING THE USE OF TOPICAL MITOMYCIN-C IN GLAUCOMA FILTRATION SURGERY

Intraoperative mitomycin C has been shown to be highly effective in in creasing the success rate of glaucoma filtration surgery. Between Octo ber 1991 and June 1992, 169 eyes of 156 patients underwent filtration procedures with intraoperative mitomycin C. In the postoperative perio d, five eyes (2.9%) developed hypotony maculopathy, characterized by d isc edema, vascular tortuosity, and chorioretinal folds in the macular area. Cryotherapy was applied to three eyes, and was effective in rev ersing the hypotony in two of them. HoWever, the visual prognosis was poor: after a mean follow up of 5.3 months (range, 3.5 to 8 months), v isual acuity returned to preoperative levels in one case. Hypotony mac ulopathy may develop after glaucoma filtration surgery with intraopera tive mitomycin C. We suggest restricting the indication of its adjunct ive use to eyes with poor surgical prognosis or those in which a very low intraocular pressure is desired. The use of extra sutures (which c an be sectioned by laser) or releasable sutures to prevent excessive f iltration in the postoperative period also is advisable.