Macular changes detected by Fourier-domain optical coherence tomography in patients with hypotony without clinical maculopathy


Robert Ritch
Glaucoma Service
Department of Ophthalmology
New York Eye and Ear Infirmary
310 East 14th Street
New York
NY 10003
Tel: + 1 212 673 5140
Fax: + 1 212 420 8743


Purpose:  To investigate macular changes in eyes with postoperative hypotony without clinical maculopathy using high-resolution Fourier-domain optical coherence tomography (FD-OCT).

Methods:  Fourteen eyes of 12 patients with postoperative intraocular pressure (IOP) ≤ 6 mmHg for at least 4 weeks but with no detectable clinical features associated with hypotony maculopathy were imaged by FD-OCT prospectively. Images were analysed by two retina specialists masked to clinical findings.

Results:  Most patients were female (83%) and myopic (75%) with a mean age of 65 ± 17 [standard deviation (SD)] years (range 2–86 years). Mean central corneal thickness was 519 ± 34 μm [95% confidence interval (CI) 502–537] and mean IOP before surgery was 20 ± 8 mmHg (95% CI 15–24). During the period of hypotony (mean 15 ± 6 weeks), the average mean IOP was 4 ± 1 mmHg (95% CI 3–5). Abnormal FD-OCT findings (retinal folds and/or intraretinal fluid) were present in eight eyes. These patients had a higher rate of visual symptoms (75% versus 17%), visual acuity loss (≥ 2 lines; 63% versus 17%) and increased mean foveal thickness (250 ± 26 versus 210 ± 12 μm; p < 0.01, Mann–Whitney U-test) compared with those with normal FD-OCT.

Conclusion:  FD-OCT identified subclinical macular abnormalities in over half of the eyes with postoperative hypotony. These findings were accompanied by visual disturbances and central macular thickening. FD-OCT can be an important diagnostic tool for this disorder when clinical features are absent.