Prolonged hypotony after deep sclerectomy may not lead to vision-threatening complications
Chronic hypotony is not uncommon following deep sclerectomy, but only a small proportion of patients with prolonged hypotony will develop complications that may threaten vision, according to a retrospective study.
“Hypotony complications might occur even in the absence of numerical hypotony in predisposed eyes. This means that numerical hypotony is neither necessary nor sufficient to develop complications,” Alessandro Rabiolo, MD, FEBO, said at the virtual American Glaucoma Society annual meeting.
Rabiolo and colleagues evaluated 1,765 eyes of 1,385 patients who underwent deep sclerectomy alone or with cataract extraction between 2001 and 2020 at two U.K. surgical centers. The researchers investigated the incidence and risk factors of hypotony and hypotony-associated complications.
Chronic hypotony was defined as IOP less than 5 mm Hg at two consecutive visits lasting longer than 90 days or any low IOP with complications or requiring surgery. In the study cohort, 228 patients (13%) were defined as having chronic hypotony at 5 years.
Of the patients with chronic hypotony, only 5.8% developed hypotony complications. Male gender and avascular blebs were confirmed as factors with increased risk for complications. In addition, non-Caucasian ethnicity, previous vitreoretinal surgery, pigmentary glaucoma and intraoperative trabeculo-Descemet’s membrane perforation were all identified as novel associations with an increased risk for hypotony complications, Rabiolo said.
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Rabiolo A, et al. Hypotony and hypotony-associated complications after deep sclerectomy: Incidence and risk factors. Presented at: American Glaucoma Society annual meeting; March 4-7, 2021 (virtual meeting).
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