Abstract
Background
A serious complication following trabeculectomy with mitomycin C (MMC) is intraocular hypotony with hypotony maculopathy, papilledema, flattening of the anterior chamber, corneal decompensation and a decrease in visual acuity. We describe a new simple surgical technique for the treatment of hypotony maculopathy following trabeculectomy with MMC.
Methods
In a prospective consecutive case study, 16 patients with hypotony maculopathy following trabeculectomy with MMC were included. Through the intact conjunctiva, additional 10.0 nylon sutures were placed through the scleral flaps into the adjacent sclera. Assessment of visual acuity, intraocular pressure (IOP) measurement and fundoscopy were performed on the 1st and 7th day postoperatively and 1, 3 and 6 months postoperatively. Photography of the bleb and the posterior pole and optical coherence tomography imaging of the posterior pole were performed.
Results
Before surgery (flap suture), the mean IOP was 2.8 mmHg (±1.1; range from 1 to 4 mmHg). It was 24.9 ± 11.7 mmHg (range; 9–48 mmHg) on the 1st postoperative day, 15.7 ±8.1 mmHg (range; 5–35 mmHg) on day 7, 11.1 ±4.1 mmHg (range; 5–20 mmHg) 1 month after surgery, 9.3 ±3.9 mmHg (range; 2–20 mmHg) after 3 months, and 9.6 ±4.2 mmHg (range; 2–20 mmHg) after 6 months. The best corrected mean visual acuity was 20/50 before trabeculectomy and 20/160 before flap suture. It improved to 20/63 at 6 months postoperatively.
Clinical signs of hypotony maculopathy disappeared in all patients. No bleb leakage was observed in any patient during follow-up.
Conclusion
Resuturing the scleral flap through the intact conjunctiva is an effective and minimally invasive method to treat hypotony maculopathy following trabeculectomy with MMC. Thus, opening the conjunctiva can be avoided.
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References
Altan T, Temel A, Bavbek T, Kazokoglu H (1994) Hypotony maculopathy after trabeculectomy with postoperative use of 5-fluorouracil. Ophthalmologica 208:318–320
Blok MD, Kok JH, van Mil C, Greve EL, Kijlstra A (1990) Use of Megasoft Bandage Lens for Treatment of Complications After Trabeculectomy. Am J Ophthalmol 110(3):264–268
Choudhri SA, Herndon LW, Damji KF, Allingham RR, Shields MB (1996) Efficacy of autologus blood injection for treating overfiltering or leaking blebs after glaucoma surgery. Am J Ophthalmol 123(4):554–555
Cohen SM, Flynn HW, Palmberg PF, Gass JD, Grajewski AL, Parrisch RK 2nd (1995) Treatment of hypotony maculopathy after trabeculectomy. Ophthalmic Surg Lasers 26(5):435–441
Costa VP, Wilson RP, Moster MR, Schmidt CM, Gandham S (1993) Hypotony maculopathy following the use of topical mitomycin c in glaucoma filtration surgery. Ophthalmic Surg 24(6):389–394
Duker JS, Schuman JS (1994) Successful surgical treatment of hypotony maculopathy following trabeculectomy with topical mitomycin C. Ophthalmic Surg 25(7):463–465
Funk J (1997) Chirurgische Revision wegen Hypotonie nach Glaukomoperation mit Mitomycin C. Ophthalmologe 94:419–423
Haynes W, Alward WM (1999) Control of intraocular pressure after trabeculectomy. Surv Ophthalmol 43(4):345–355
Haynes W, Alward WM (1999) Combination of autologous blood injection and bleb compression sutures to treat hypotony maculopathy. J Glaucoma 8:384–387
Klink T, Lieb WE, Göbel W (2000) Frühe und späte Befunde der optischen Kohärenztomographie (OCT) bei Patienten mit postoperativer Hypotonie. Ophthalmologe 97:353–358
Leen MM, Moster MR, Katz LJ, Terebuh AK, Schmidt CM, Spaeth GL (1995) Management of overfiltering and leaking blebs with autologous blood injection. Arch Ophthalmol 113:1050–1055
Morgan JE, Diamond JP, Cook SD (2002) Remodelling the filtration bleb. Br J Ophthalmol 86:872–875
Myers JS, Yang ChB, Herndon LW, Allingham RR, Shields B (2000) Excisional bleb revision to correct overfiltration or leakage. J Glaucoma 9:169–173
Nuyts RM, Greve EL, Geijssen HC, Langerhorst CHT (1994) Treatment of hypotonous maculopathy after trabeculectomy with mitomycin C. Am J Ophthalmol 118:322–331
Shirato S, Maruyama K, Haneda M (2004) Resuturing the scleral flap through conjunctiva for treatment of excess filtration. Am J Ophthalmol 137(1):173–174
Schwartz GF, Robin AL, Wilson RP, Suan EP, Pheasant TR, Prensky JG (1996) Resuturing the scleral flap leads to resolution of hypotony maculopathy. J Glaucoma 5(4):246–251
Stamper RL, McMenemy MG, Lieberman MF (1992) Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil. Am J Ophthalmol 114(5):544–553
Suner IJ, Greenfield DS, Miller MP, Nicolela MT, Palmberg PF (1997) Hypotony maculopathy after filtering surgery with mitomycin C – incidence and treatment. Ophthalmology 104(2):207–216
Van Herick W, Shaffer RN, Schwartz A (1969) Estimation of width of angle of anterior chamber. Incidence and significance of the narrow angle. Am J Ophthalmol 68(4):626–629
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Eha, J., Hoffmann, E.M., Wahl, J. et al. Flap suture - a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol 246, 869–874 (2008). https://doi.org/10.1007/s00417-007-0694-2
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DOI: https://doi.org/10.1007/s00417-007-0694-2