✍️low IOP usually < 5 mm Hg leading to functional and structural changes in the eye.
✍️ The most common setting for hypotony maculopathy is in association with glaucoma filtration surgery, in which 1.3% to 3% of patients may develop maculopathy.
✍️ Central visual loss may result from irregular folding of the retina and choroid in the macula.
✅Hypotony maculopathy clinical picture
✍️ Symptoms
☝️ central visual loss
☝️ metamorphopsia
✍️ signs
☝️ corneal oedema
☝️ low IOP
☝️ may be lost AC
☝️ irregular retinal and choroidal folds radiating temporally from the optic nerve.
☝️ The peripapillary choroid is frequently engorged and may mimic papilledema.
☝️ In severe cases, the insertion of the inferior oblique muscle may visibly produce an internal compression of the macula.
☝️ Prolonged hypotony leads to the formation of permanent pigment lines in the macular region.
☝️ Severe chronic cases of hypotony may result in atrophia bulbi.
✅Hypotony maculopathy Ancillary Testing
✍️ Diagnostic testing is primarily directed toward the identification of the cause of hypotony.
✍️ Anterior segment imaging with gonioscopy or ultrasound biomicroscopy may be useful in the diagnosis of cyclodialysis clefts.
✍️ FFA shows
☝️ alternating lines of hyperfluorescence (peaks) and hypofluorescence (troughs).
☝️ At peaks, the RPE is stretched and thinned, allowing increased fluorescent signal from the underlying choroid
☝️ at troughs, the fluorescent signal is blocked by ‘bunching up’ of the RPE.
✍️ On OCT, choroidal folds appear
☝️ undulations of the RPE, without evidence of separation from Bruch’s membrane.
☝️ OCT also allows easy differentiation between choroidal folds and retinal striae (occurs in some eyes with ERM).
✅Hypotony maculopathy Pathology and Pathogenesis
✍️ hypotony can be classified according to mechanisms including
☝️ external fistula
• accidental
• surgical trauma
• glaucoma surgeries
☝️ internal fistula
• connect the suprachoroidal space with the aqueous
• connect suprachoroidal space to vitreous
• cyclodialysis
• retinal detachment.
☝️ ciliary body insufficiency
☝️ ciliary body inflammation
• medications
• surgical interventions.
• reduction in aqueous production
☝️ ocular ischemia
☝️ giant cell arteritis
☝️uremia
☝️myotonic dystrophy
✅Hypotony maculopathy Treatment
✍️ identification and correction of the etiology of hypotony is mainstay treatment .
✅Hypotony maculopathy prognosis
✍️ The visual prognosis is variable.
✍️ several case series have described good visual recovery with reversal of hypotony, other series have poorer visual outcomes despite normalization of intraocular pressure.
✍️ In cases of prolonged hypotony, the chorioretinal folds persist even after the intraocular pressure is normalized.
✍️ Systemic Evaluation
☝️ Hypotony maculopathy usually does not have systemic manifestations.
☝️ systemic causes of hypotony include
• myotonic dystrophy
• ocular ischemia related to carotid occlusive disease
• giant cell arteritis.
• uremia
