Risk factors for hypotony maculopathy include youth, myopia

Young age, male gender and myopia are significant risk factors for hypotony maculopathy, a large retrospective study found. A history of diabetes and the presence of choroidal effusion were associated with decreased risk for developing the disease in the study.

Lilia A. Fannin, MD, Joyce Schiffman, MS and Donald Budenz, MD, of Miami’s Bascom Palmer Eye Institute, reviewed the charts of 228 patients with hypotony seen over the course of 13 years. The authors defined hypotony as intraocular pressure of less than 5 mm Hg. Of the patients reviewed, 81 had hypotony maculopathy and 147 had hypotony alone. Those with hypotony alone served as controls.

Hypotony maculopathy is a rare complication of glaucoma filtering surgery, trauma and other anterior segment surgeries. It is reported to occur in 1.3% to 18% of cases after glaucoma filtering surgery, the authors noted.

Patients with hypotony maculopathy were significantly younger than patients with hypotony alone by an average 20 years. More of the patients with hypotony maculopathy were male (54.3%) than were controls (33.6%). Hypertension was less frequent in the eyes with hypotony maculopathy (24.7%) than in control eyes (50.3%). Patients with hypotony maculopathy also had a lower incidence of diabetes (4.9%) than control patients (16.3%).

The phakic eyes with hypotony maculopathy were more myopic than the phakic control eyes.

The authors concede their study “has several potential flaws.” Because all cases were seen in a tertiary referral center, it is possible only the most severe of cases were seen. Also, because the study was retrospective, the possibility exists that some patients may have had undiagnosed maculopathy. They also acknowledged that the numbers in the subcategories were small.

“Our results showed a trend of hypotony maculopathy to occur more often in eyes with pigmentary glaucoma and juvenile open-angle glaucoma,” the authors reported in the June issue of Ophthalmology.