Abstract

FR.11.03

Flap suture through the conjunctiva in patients with hypotony maculopathy after trabeculectomy: one-year follow-up results

Eha J., Hoffmann E., Wahl J., Pfeiffer N.
Johannes-Gutenberg-University Mainz, Department of Ophthalmology

Objective: One of the complications following trabeculectomy with Mitomycin C (MMC) is ocular hypotony. It is characterized by choroidal folds at the posterior pole, papilledema and decrease in visual acuity. Other signs might be corneal decompensation and flattening of the anterior chamber.
We describe the one-year follow-up results of a new surgical technique for treatment of hypotony maculopathy after trabeculectomy with MMC.
Methods: In a prospective consecutive study 16 patients with hypotony maculopathy after trabeculectomy with MMC were included. Nylon sutures were placed through the closed conjunctiva into the scleral flap to reduce the outflow. Assessment of visual acuity, intraocular pressure measurement (IOP), optical coherence tomography, funduscopy was performed on the first and seventh day postoperatively and one, three, six and twelve months after surgery.
Results: Before surgery (flap suture) the best corrected visual acuity was 20/160 versus 20/50 before trabeculectomy. The mean IOP increased from 2.8 mm Hg (±1.1) preoperatively to 24.9 mm Hg (±11.7) mm Hg on the first postoperative day to 15.7 mm Hg (±8.1) on day seven and decreased to 11.1 mm Hg (±4.1) mmHg one month after surgery and to 9.6 mm Hg (±4.2) six month after surgery and to 13.5 mm Hg after twelve months. The mean visual acuity stabilized from 20/160 preoperative to 20/100 after seven days to 20/63 after three months and 20/50 after six months. The clinical hypotonic signs diminished in all patients and surgery could be done without any complications.
Conclusions: Resuturing the scleral flap through intact conjunctiva is an effective and minimal invasive method in persistent hypotony maculopathy also in one-year follow-up. Reopening of the conjunctiva with the potential effect of enhancing bleb scaring can be avoided.

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