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Find causes of hypotony, take conservative approach to treatment first
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HONG KONG — A bleb leak that does not close spontaneously is a sign of hypotony and should be treated to prevent endophthalmitis, a glaucoma expert said.
 Marlene R. Moster |
Marlene R. Moster, MD, outlined the causes and best treatment of hypotony at the World Ophthalmology Congress meeting here. She said the incidence of hypotony, a serious, sight-threatening condition, has increased from 10% to more than 30%. Pinpointing why it has occurred and revising the bleb is important to treating the condition.
"Treat hypotony associated with a bleb chamber in a timely manner," she said. "Try conservative treatment first, and then move on to surgical intervention if necessary."
She said the first line of treatment for the condition is bandage contact lens and antibiotics. Patching, changing topical steroid drops, cryotherapy or the use of Nd:YAG laser are also effective treatments, she said.
However, if a patient shows no improvement after those treatments, then surgical intervention is indicated, she said.
Hypotony occurs for numerous reasons. A hole or leak in the bleb or overfiltration can be the main causes of the condition, Dr. Moster said. Overfiltration can happen because of various surgical factors. Several causes involve performing surgical steps at the wrong times, including cutting too early with the laser or removing releasable sutures too soon, she said.
Also, not tying the flap down tightly enough or a suture that comes undone accidentally can also cause overfiltration, Dr. Moster said.
Additional causes of hypotony can be aqueous suppression with a combination of beta blockers and carbonic anhydrase inhibitors, she said.
Wills Eye Institute, where Dr. Moster is based, has devised a grading system to rate hypotony, she said. The first grade is shallowing of the anterior chamber. The second grade is cornea-to-iris touch but not with pupil-lens involvement, she said. The third and last grade is complete touch of lens, iris and cornea.
Dr. Moster called the final grade an "ophthalmic emergency" that must be treated immediately.