Kao Shu-Ting, Lee Shwu-Huey, Chen Yi-Chun
Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan.
J Glaucoma. 2017 Apr;26(4):e137-e141. doi: 10.1097/IJG.0000000000000485.
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.
低眼压性黄斑病变是小梁切除术后一种威胁视力的并发症。我们报告了一名34岁患有青少年开角型青光眼和高度近视的男性，他在小梁切除术后14年发生了低眼压性黄斑病变，且无滤过泡渗漏。这是已知小梁切除术后至发生无滤过泡渗漏的低眼压性黄斑病变的最长时间。高度近视患者发生迟发性低眼压性黄斑病变的可能机制是巩膜渐进性变薄、巩膜硬度降低以及随着年龄增长巩膜形态改变。这些变化可能会削弱巩膜的生物力学特性，进而导致低眼压时巩膜壁塌陷。该病例提醒我们，即使无滤过泡渗漏，低眼压性黄斑病变也可能在小梁切除术后长达14年发生，对于患有青少年开角型青光眼的高度近视患者，小梁切除术后应避免出现低眼压。
