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Bleb revision for hypotony maculopathy improves visual acuity, IOP
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Surgical bleb revision for hypotony maculopathy significantly increased IOP and improved visual acuity for up to 1 year, according to study findings.
The retrospective, non-comparative case series included 33 eyes of 33 patients who underwent primary bleb revision between 1999 and 2012.
Researchers classified hypotony maculopathy by a decrease in VA, retinal striae and macular
edema amid decreased IOP after glaucoma filtration surgery. The study’s primary outcome was final visual acuity after bleb revision at 6 and 12 months.
Mean interval between diagnosis of hypotony maculopathy and bleb revision was 4.98 months.
VA improved significantly from 0.78 at baseline to 0.34 at 6 months and 0.45 at 12 months, according to the researchers
The researchers found mean IOP increased from 3.51 mm Hg to 12.06 mm Hg at 12 months, which was sustained for 12 months in 31 patients (94%).
A second bleb revision was required to correct persistent hypotony maculopathy in five eyes (15%). No patients required additional glaucoma surgery to manage IOP; 16 patients (48.5%) required topical medications to control IOP, according to the researchers.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
Perspective
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Douglas J. Rhee, MD
The study by Caprioli, et al. helps to provide some evidence toward an area that has largely been managed anecdotally. Consensus among glaucoma and retina specialists regarding the timing of bleb revision for hypotony maculopathy is not completely aligned, with some feeling that very early intervention is required, whereas many have anecdotal experience with patients doing well even years later. This manuscript shows that patients who underwent bleb revision after months with hypotony can do very well. Additionally, patients should be counseled that visual improvement takes months to occur so that they can have appropriate potential expectations from the intervention.
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