Characteristics and Treatment Outcomes of Hypotony Maculopathy Post-Glaucoma Filtering Surgery: An Optical Coherence Tomography-Based Study

Alicja Strzalkowska; Lisa Rennert; Piotr Strzalkowski; Julia V Stingl; Esther M Hoffmann; Norbert Pfeiffer; Alexander K Schuster

doi:10.1097/IJG.0000000000002413

Characteristics and Treatment Outcomes of Hypotony Maculopathy Post-Glaucoma Filtering Surgery: An Optical Coherence Tomography-Based Study

J Glaucoma. 2024 May 6. doi: 10.1097/IJG.0000000000002413. Online ahead of print.

Authors

Alicja Strzalkowska^{1

2}, Lisa Rennert¹, Piotr Strzalkowski², Julia V Stingl¹, Esther M Hoffmann¹, Norbert Pfeiffer¹, Alexander K Schuster¹

Affiliations

¹ Department of Ophthalmology, Mainz University Medical Centre of the Johannes Gutenberg, University of Mainz, Mainz, Germany.
² Department of Ophthalmology, Heinrich-Heine-University, University Hospital Düsseldorf, Germany.

PMID: 38709193
DOI: 10.1097/IJG.0000000000002413

Abstract

Purpose: This study assesses morphological characteristics using SD-OCT in patients with hypotony maculopathy (HM) following glaucoma filtering surgery and evaluates the results of its treatment.

Material and methods: Retrospective analysis of all HM patients between January 2019 and March 2023. Inclusion criteria consisted of both pre-operative and post-revision SD-OCT images of the macula and the presence of HM as observed on OCT images preoperatively. HM was graded according to its appearance in OCT both pre- and post-revision surgery. Change in visual acuity and IOP were assessed.

Results: 45 eyes of 45 patients were included. 21 eyes had HM limited to retinal pigment epithelium (RPE), 18 eyes had involvement of RPE and photoreceptor layers and 6 eyes had additional intra- or subretinal edema. After revision surgery with IOP elevation, 64% of eyes had complete HM regression with no HM signs in OCT imaging. 80% of patients achieved at least one grade improvement in HM. Preoperative visual acuity increased from 0.7±0.4 (logMAR) to 0.4±0.4 at 2 weeks postoperatively, over the course of an increase of IOP from 3.5±1.8 mmHg to 17.1±10.6 mmHg at day one. Eyes with complete HM regression had higher IOP at day 1 compared to those without improvement (P=0.04). The median time between HM onset and revision was 10.0 days for those with complete regression and 27 days for those without improvement (P=0.04).

Conclusions: Bleb revision procedures for HM following glaucoma filtering surgery show promising outcomes, including notable improvements in visual acuity and IOP. The timing of revision surgery appears to influence outcome. In our study earlier intervention was associated with better results. Even delayed surgeries can lead to an improvement, although complete morphological restoration may not be achieved in advanced grades of HM.