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Practicalities
Erik L. Greve and H. Caroline Geijssen
Hypotonous Maculopathy: How do we deal with it?
I Prevention
1. surgical technique
- posterior conjunctival incision
- large scleral flap
- avoid limbal conjunctiva
- tight sutures
- lowest possible concentration and duration of antimetabolites
new options:
- intrascleral bleb
- posterior bleb (as in drainage devices)
2. postoperative management
- careful suturelysis, not too early,
- early autologous blood injections (see also under 'treatment')
II Treatment of over-functioning (cystic, avascular) blebs or leakage
1. autologous blood injections
2. a - external approach: excision and conjunctival advancement
b - internal approach:
-extra sutures
- introduction of tenon or dried fascia with or without autologous blood