Ocular Hypotony Follow-up

  • Author: Sheila P Sanders, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 9, 2010
 

Further Outpatient Care

  • Patients with ocular hypotony should receive vigilant follow-up care until the hypotony and the underlying cause have been stabilized.
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Deterrence/Prevention

  • Hypotony following glaucoma surgery can be prevented in several ways.
    • Consider lowering the exposure time and the concentration of antimetabolites, if used.
    • Using releasable sutures or placing extra sutures (which can be removed with laser suture lysis) in the trabeculectomy flap may prevent overfiltration.
    • For tube shunts, choosing a valved device or modifying the shunt with suture material can slow drainage.
    • Many glaucoma surgeons leave the anterior chamber inflated with viscoelastic at the end of each case.
    • Aggressive use of anti-inflammatory agents can help prevent the cycle of iridocyclitis and hypotony.
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Complications

  • Corneal decompensation, synechiae, cataract formation, and chronic retinal edema or folds may occur. Hypotony maculopathy can cause permanent retinal pigment epithelium (RPE) disruption.
  • If suprachoroidal hemorrhage develops, the results are often catastrophic for the eye.
  • Prolonged hypotony may lead to prephthisis or phthisis bulbi.
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Prognosis

  • Prognosis varies with the cause and the extent of hypotony.
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Patient Education

  • Patients should be educated about the cause and the implications of this condition. Better understanding may help the patient to be more compliant with treatment and follow-up care. Patients should also be warned of the potential chronicity of hypotony. Improvement in visual acuity often lags behind the resolution of hypotony.
  • Emphasize activity limitations, use of eye shield, compliance with medications, and increased fluid intake.
  • Encourage patients to contact their provider if their situation seems to be worsening.
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Contributor Information and Disclosures
Author

Sheila P Sanders, MD  Associate Professor, Director of Glaucoma Service, Department of Ophthalmology, University of Kentucky College of Medicine

Sheila P Sanders, MD is a member of the following medical societies: American Academy of Ophthalmology and American Glaucoma Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Bradford Shingleton, MD  Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Fannin LA, Schiffman JC, Budenz DL. Risk factors for hypotony maculopathy. Ophthalmology. Jun 2003;110(6):1185-91. [Medline].

  2. Hammer ME, Grizzard WS. Endoscopy for evaluation and treatment of the ciliary body in hypotony. Retina. Feb 2003;23(1):30-6. [Medline].

  3. Ugahary LC, Ganteris E, Veckeneer M, Cohen AC, Jansen J, Mulder PG, et al. Topical ibopamine in the treatment of chronic ocular hypotony attributable to vitreoretinal surgery, uveitis, or penetrating trauma. Am J Ophthalmol. Mar 2006;141(3):571-3. [Medline].

  4. Aminlari A, Callahan CE. Medical, laser, and surgical management of inadvertent cyclodialysis cleft with hypotony. Arch Ophthalmol. Mar 2004;122(3):399-404. [Medline].

  5. Sarkisian SR Jr. Tube shunt complications and their prevention. Curr Opin Ophthalmol. Mar 2009;20(2):126-30. [Medline].

  6. Budenz DL, Chen PP, Weaver YK. Conjunctival advancement for late-onset filtering bleb leaks: indications and outcomes. Arch Ophthalmol. Aug 1999;117(8):1014-9. [Medline].

  7. Fine HF, Biscette O, Chang S, Schiff WM. Ocular Hypotony: A Review. Comprehensive Ophthalmology Update. Jan-Feb 2007;8:29-37.

  8. Haynes WL, Alward WL. Control of intraocular pressure after trabeculectomy. Surv Ophthalmol. Jan-Feb 1999;43(4):345-55. [Medline].

  9. Hsu J, Chen E, Gupta O, Fineman MS, Garg SJ, Regillo CD. Hypotony after 25-gauge vitrectomy using oblique versus direct cannula insertions in fluid-filled eyes. Retina. Jul-Aug 2008;28(7):937-40. [Medline].

  10. Kunimoto DY, Kenitkar KD, Makar M. Hypotony. In: The Will's Eye Manual. Lippincott, Williams, & Wilkins; 2004:440-442.

  11. Migdal C, Hitchings R. Morbidity following prolonged postoperative hypotony after trabeculectomy. Ophthalmic Surg. Dec 1988;19(12):865-7. [Medline].

  12. Nicolela MT, Carrillo MM, Yan DB, Rafuse PE. Relationship between central corneal thickness and hypotony maculopathy after trabeculectomy. Ophthalmology. Jul 2007;114(7):1266-71. [Medline].

  13. O'Connell SR, Majji AB, Humayun MS, de Juan E Jr. The surgical management of hypotony. Ophthalmology. Feb 2000;107(2):318-23. [Medline].

  14. Pederson J. Ocular hypotony. In: Duane's Clinical Ophthalmology. Vol 3. 1993.

  15. Ritch R, Shields MB, Krupin T. Ocular hypotony. In: The Glaucomas. Vol 3. 1996:385-395.

  16. Roters S, Szurman P, Engels BF, Bartz-Schmidt KU, Krieglstein GK. Ultrasound biomicroscopy in chronic ocular hypotony: its impact on diagnosis and management. Retina. Oct 2002;22(5):581-8. [Medline].

  17. Schubert HD. Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous. Surv Ophthalmol. Sep-Oct 1996;41(2):97-125. [Medline].

  18. Suner IJ, Greenfield DS, Miller MP, Nicolela MT, Palmberg PF. Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology. Feb 1997;104(2):207-14; discussion 214-5. [Medline].

  19. Walker SD, Brubaker RF, Nagataki S. Hypotony and aqueous humor dynamics in myotonic dystrophy. Invest Ophthalmol Vis Sci. Jun 1982;22(6):744-51. [Medline].

 
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Seidel-positive wound leak around a conjunctival suture.
Conjunctival advancement flap sewn over a diffusely incompetent bleb.
Eroded tube shunt in a patient with rheumatoid arthritis.
Flat anterior chamber with iris-corneal touch following a phacotrabeculectomy.
Autologous blood injected into an overfiltering bleb to create a blood patch.
B-scan ultrasound of choroidal effusions before and after surgical drainage.
 
 
 
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