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Editors Selection IGR 23-4

Surgery: Hypotonus maculopathy and SD-OCT

Comment by Shan Lin on:

26651 Three-dimensional high-speed optical coherence tomography for diagnosis of hypotony maculopathy after glaucoma filtration surgery, Goodkin ML; Grewal DS; Greenfield DS, Journal of Glaucoma, 2010; 19: 349-355

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Goodkin et al. (1443) describe the three-dimensional optical coherence tomography (OCT) findings, as compared to time domain OCT, in seven cases of hypotonous maculopathy. This was an observational, non-comparative study in which three types of spectral domain OCT (SDOCT) were used (Topcon 3D OCT [Topcon, Tokyo, Japan], RTVue [Optovue, Fremont, CA], and Cirrus HD-OCT [Carl Zeiss Meditec, Dublin, CA]) to evaluate the three-dimensional structure of the macula in eyes with clinical hypotonous maculopathy. The 'cross hair' setting of the time domain OCT (Stratus OCT, Carl Zeiss Meditec, Dublin, CA) was only able to detect choroidal undulation in two out of the seven cases, whereas the 3-D scans of the SDOCTs demonstrated macular folds in all cases. In four cases, the foveal avascular zone was not affected on the 3-D scanning. In all those cases the best corrected visual acuity was 20/25 or better, consistent with the SDOCT findings. The SDOCT appears to have an enhanced capability to correlate structural findings to the clinical presentation in cases of hypotonous maculopathy. Unfortunately, this clinical entity is not such a rare occurrence after filtering surgery, particularly in this age of mitomycin C usage. The ability to characterize this condition structurally can help guide its treatment and perhaps predict outcome.

SDOCTs have increased scanning speed and resolution compared to the prior generation time domain OCTs. In addition to the possible improved diagnosis and follow-up of glaucoma patients, these devices can now assist in managing cases of too low intraocular pressure.

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