Management of hypotony after trabeculectomy with mitomycin C

Abstract

The purpose of this study was to determine the incidence and risk factors of hypotony and the effectiveness of medical and surgical treatment. A total 117 eyes of 103 patients that underwent trabeculectomy with mitimycin C (MMC) between 1993 and 2000 were reviewed. Hypotony was treated with the following methods in a stepwise manner: medical treatment, intrableb autologous blood injection, additional sutures to the scleral flap, necrotic bleb excision and advancement of the forniceal conjunctival flap. Hypotony developed in 30 eyes (25.6%) of 26 patients, among, which hypotonic maculopathy developed in 11 eyes (9.4%). The risk factors of hypotony were young age and primary open angle glaucoma. Because of no light sense, 6 of the 30 hypotonic eyes were not treated. Nineteen (79.2%) of the 24 treated hypotonic eyes were successfully managed. Five eyes, 3 with hypotony but maintaining visual acuity and 2 with follow-up loss, were not included in the success group. The mean intraocular pressure (IOP) before treatment, 2.5 +/- 1.2 mmHg, increased to 8.3 +/- 4.0 mmHg at 18.5 months follow-up. The stepwise treatment seems to be a useful method to manage hypotony after trabeculectomy with MMC.

Resultados da associação trabeculotomia-trabeculectomia em pacientes não idosos

“…A hipotonia, se considerada como PIO igual ou inferior a 6 mmHg, não é relatada em nenhum dos trabalhos em que a trabeculotomia foi utilizada isoladamente, para tratamento do glaucoma juvenil ou do adulto (4,5,16,(19)(20)(21)(22)(23)(24)(25)33) . A ocorrência de hipotonia é sabidamente mais freqUente em pacientes jovens e sua incidência em três (15,78%) dos 19 olhos, em pacientes com média de idade de 34,33 anos (27, 30 e 46 anos), não é superior à relatada por alguns autores em trabeculectomias isoladas (37,38) . É importante ressaltar que, para a realização da trabeculotomia associada à trabeculectomia, para facilitar a identificação do canal de Schlemm, confeccionou-se o retalho escleral com as incisões radiais tendo seus limites anteriores muito à frente, ao nível de limbo, o que deve expor os olhos a um maior risco de hipotonia, principalmente em pacientes jovens (39) .…”

The treatment of ocular hypotony after trabeculectomy with a scleral lens: A case series

“…Several methods of management of post-operative hypotony have been developed [5,7,8]. Treatment algorithms for ocular hypotony are proposed by Tunç et al and Hyung et al [7,8]. However, treatment is dependent on correctly identifying the cause of the hypotony [5].…”

“…However, in selected cases various kinds of tamponade may be adequate. Examples of tamponades applied are a pressure patch, a (large) soft bandage lens, a symblepharon ring or a Simmons shell [3,5,7,8,[11][12][13][14][15][16].…”

Reconstruction of delayed scleral flap melting with bovine pericardium after trabeculectomy with mitomycin C

“…Although associated to some possible complications, trabeculectomy remains the mainstay of surgical management of glaucoma [1], [2]. The advent of antimetabolite adjunctive therapy has increased the success rate of this procedure due to his antifibrotic action.…”