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Tip of the Month
Tip of the month - Early bleb revision usually results in successful resolution of hypotony maculopathy after trabeculectomy with mitomycin C
Early bleb revision usually results in successful resolution of hypotony maculopathy after trabeculectomy with mitomycin C

Publishing date: January 2019

Tip Editor: John Salmon
Tip reviewer: Roger Hitchings


The Science behind the Tip

Hypotony maculopathy is characterized by painless loss of vision usually more than three months after glaucoma filtration surgery, particularly if an anti-metabolite has been used. An IOP of <6mmHg is associated with macular folds. Risk factors for this complication include: male gender, myopia and young age (1).

Non-invasive options have been tried in the past, but are not usually successful (1). The key to the management is early bleb revision. Thin and leaking conjunctiva is removed, normal conjunctiva is advanced and sutured at the limbus. The procedure is safe, effective and results in visual improvement (2,3). A large study reported an average IOP at 1 year of 12mmHg after revisional surgery (2). A second procedure is needed in 10-15% (2,3).

Contributor: John F Salmon MD - Oxford



References

1. Costa VP, Arcieri ES. Hypotony maculopathy. Acta Ophthalmol Scand. 2007; 85:586-597.

2. Bitrian E, Song BJ, Caprioli J. Bleb revision for resolution of hypotonous maculopathy follow primary trabeculectomy. Am J Ophthalmol. 2014; 158:597-604.

3. Radhakrishnan S, Quigley HA, Jampel HD et al. Outcomes of surgical bleb revision for complications of trabeculectomy. Ophthalmol 2009; 116:1713-8.



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