Late-onset Hypotony Maculopathy After Trabeculectomy in a Highly Myopic Patient With Juvenile Open-angle Glaucoma

Abstract

Hypotony maculopathy is a sight-threatening complication after trabeculectomy. We report on a 34-year-old man with juvenile open-angle glaucoma and high myopia, who developed hypotony maculopathy 14 years after trabeculectomy without bleb leak. This represents the longest known period from trabeculectomy to the development of hypotony maculopathy without bleb leak. The possible mechanisms for the development of late-onset hypotony maculopathy in the highly myopic patient are progressive scleral thinning, reduced scleral rigidity, and scleral morphologic change with aging. These changes might weaken the biomechanical properties of sclera and then contribute to the collapse of the scleral wall during hypotony. This case serves as a reminder that hypotony maculopathy can happen up to 14 years after tabeculectomy even without bleb leak and hypotony should be avoided after trabeculectomy in highly myopic patients with juvenile open-angle glaucoma.

FIGURE 1

Annual average intraocular pressure (IOP) after trabeculectomy.

FIGURE 2

Annual average spherical equivalent (SE) before and after trebeculectomy. The right eye showed a trend of hyperopic shift, while the SE of the left eye is steady.

FIGURE 3

Fundus photography of the right eye. A, Glaucomatous optic disc change with normal appearance of macula in November 2014 before the development of hypotony maculopathy. B, Irregular retinal folds radiating outward from the fovea and optic disc swelling, surrounded by tortuous retinal vessels in March 2015.

FIGURE 4

Optical coherence tomography using Cirrus HD-OCT showed chorioretinal foldings in the macular area of the right eye in March 2015.

FIGURE 5

Macular scan using Cirrus HD-OCT of both eyes. A, Retinal thickness at the macular area in November 2014 before the development of hypotony maculopathy. B, Thickening of the retina at the macular area was noted on the right eye in March 2015.

FIGURE 6

Optic nerve head and retinal nerve fiber layer (RNFL) scan using Cirrus HD-OCT of both eyes. A, Peripapillary RNFL and neuroretinal rim thinning of both eyes were confirmed in November 2014 before the development of hypotony maculopathy. B, Peripapillary RNFL and neuroretinal rim thickening of the right eye were noted in March 2015.