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.