Hypotony maculopathy

Hypotony maculopathy is maculopathy due to very low intraocular pressure known as ocular hypotony. Maculopathy occurs either due to increased outflow of aqueous humor through angle of anterior chamber or less commonly, due to decreased aqueous humor secretion by ciliary body.

Hypotony maculopathy
SpecialtyOphthalmology,
Symptomsblurry vision, vision loss
ComplicationsBlindness
CausesLow intraocular pressure
Diagnostic methodEye examination

Description

Hypotony maculopathy is maculopathy due to ocular hypotony.[1] Fundus examination may reveal abnormalities like chorioretinal folds, optic nerve head swelling (papilledema) and tortuosity of blood vessels.[1]

Causes

Maculopathy occurs either due to increased outflow of aqueous humor through angle of anterior chamber or less commonly, due to decreased aqueous humor secretion by ciliary body.[2]

Chronic inflammation within the eye including iridocyclitis, medications including anti glaucoma drugs, or proliferative vitreoretinopathy causes decreased production.[3][4] Increased outflow or aqueous loss may occur following a glaucoma surgery, trauma, post-surgical wound leak from the eye, cyclodialysis cleft, tractional ciliary body detachment or retinal detachment.[3] Use of anti fibrosis drugs like mitomycin C during glaucoma surgery will increase the risk of hypotony maculopathy development.[2]

Investigations

Many ophthalmic imaging techniques are used in detecting hypotony maculopathy. Indocyanine green angiography or fluorescein angiography can help in early detection of choroidal disturbances and choroidal folds.[5][2] Medical ultrasound may be used to detect scleral and choroidal thickening, anterior chamber depth, ciliary detachment and cyclodialysis cleft.[2] OCT scanning can be used in detecting abnormalities of retina and choroid.[6]

Treatment

To prevent retinal dysfunction and vision loss, intraocular pressure should be normalised by treating the cause of hypotony.[7] Delay in treatment results in permanent chorioretinal changes and permanent loss of vision.[7]

History

Dellaporta first described the condition in 1954.[8] Gass, in 1972, named it hypotony maculopathy.[9]

References
  1. "Hypotony Maculopathy - EyeWiki". eyewiki.aao.org. Retrieved 2022-04-13.
  2. "Assessing and Managing Hypotony Maculopathy". American Academy of Ophthalmology. 2009-10-01. Retrieved 2022-04-14.
  3. Fine, Howard F.; Biscette, O'neil; Chang, Stanley; Schiff, William M. (January 2007). "Ocular hypotony: a review". Comprehensive Ophthalmology Update. 8 (1): 29–37. ISSN 1527-7313. PMID 17394757.
  4. "Ocular Hypotony: Background, Pathophysiology, Epidemiology". 19 July 2021.
  5. Masaoka, N.; Sawada, K.; Komatsu, T.; Fukushima, A.; Ueno, H. (May 2000). "Indocyanine green angiographic findings in 3 patients with traumatic hypotony maculopathy". Japanese Journal of Ophthalmology. 44 (3): 283–289. doi:10.1016/s0021-5155(99)00222-1. ISSN 0021-5155. PMID 10913648.
  6. Budenz, Donald L.; Schwartz, Kenneth; Gedde, Steven J. (2005-01-01). "Occult Hypotony Maculopathy Diagnosed With Optical Coherence Tomography". Archives of Ophthalmology. 123 (1): 113–114. doi:10.1001/archopht.123.1.113. ISSN 0003-9950. PMID 15642824.
  7. Lee, Yun Jeong; Woo, Se Joon (2021-05-07). "Hypotony maculopathy and photoreceptor folds with disruptions after vitrectomy for epiretinal membrane removal: two case reports". Journal of Medical Case Reports. 15 (1): 255. doi:10.1186/s13256-021-02824-3. ISSN 1752-1947. PMC 8103759. PMID 33957968.
  8. Costa, Vital Paulino; Arcieri, Enyr Saran (September 2007). "Hypotony maculopathy". Acta Ophthalmologica Scandinavica. 85 (6): 586–597. doi:10.1111/j.1600-0420.2007.00910.x. ISSN 1395-3907. PMID 17542978.
  9. "Hypotony Maculopathy After Phacoemulsification". Retina Today. Retrieved 2022-04-14.
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