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Abstract #5890 Published in IGR 2-1
Hypotony after glaucoma filtration surgery
Rahman A; Mendonca M; Simmons RB; Simmons RJInternational Ophthalmology Clinics 2000; 40/1: 127-136
this review of hypotony after filtration surgery starts with a definition: hypotony is an intraocular pressure below 6 mmHg. A more useful definition would include the effect of hypotony on visual function. The article discusses the histopathological effects of mitomycine-c after trabeculectomy in human glaucomatous eyes with persistent hypotony. They go into the etiology of hypotony: early; decreased aqueous production; cilio-choroidal detachment; excessive aqueous outflow due to overfiltration or woudleak, globe perforation, retinal detachment, iridocyclitis; followed by chronic hypotony: leaks in the conjunctiva, cyclodialysis clefts, excessive filtration from an over-functioning bleb, cyclitic membrane. The incidence of chronic hypotony after trabeculectomy surgery with antimetabolites has increased. The use of antifibrosis agents must be judicious, both as regards the amount and the time used on the scleral flap. Tight closure of the scleral flap should be ensured, and attention must be given to proper timing and release of teh scleral flap suture. In the face of hypotony, a good evaluation and a management plan should be considered. Conservative treatment, including manipulation of medication, use of oversized bandage lens, and Simmons shell, postoperatively may decrease the likelihood o serious postoperative complications and a need for surgical revision. Future clinical trials should evaluate the role of trabeculectomy with mitomycine-C in various populations of patients, including those undergoing primary filtering procedures. We should attempt to determine optimal concentration and application time for mitomycine-c, according to the diagnosis, surgical history, and other patient characteristics. We also should investigate the incidence and duration of hypotony and loss of visual acuity in the intermediate and longterm in hypotonous eyes.
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
