Successful surgical treatment of hypotony maculopathy following trabeculectomy with topical mitomycin C

Hypotony maculopathy, a clinical syndrome consisting of choroidal folds, retinal folds, and optic disc edema, results from severe, chronically decreased intraocular pressure (IOP). Conventional therapy consists of procedures designed to normalize the IOP. We treated a patient who developed hypotony maculopathy following trabeculectomy with mitomycin C. Despite normalization of the IOP with bleb revision, neither the posterior segment architecture nor visual acuity improved. Vitrectomy with mechanical flattening of the posterior segment via intraoperative instillation of perfluorocarbon liquid was performed. The choroidal folds resolved and visual acuity improved from 20/200 to 20/20. In eyes with hypotony maculopathy in which the posterior segment anatomy and visual acuity do not improve after IOP normalization, vitrectomy with heavier-than-water liquids may improve vision.