Cohen S M, Flynn H W, Palmberg P F, Gass J D, Grajewski A L, Parrish R K
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, FL, USA.
Ophthalmic Surg Lasers. 1995 Sep-Oct;26(5):435-41.
To determine if resuturing of the scleral flap to increase IOP in the post-trabeculectomy eye is an effective treatment of hypotony maculopathy.
The medical records of nine consecutive patients who developed visual acuity loss after trabeculectomy related to hypotony maculopathy were reviewed to determine factors that contribute to successful restoration of visual acuity. The average age of the patients was 50 years and average refractive error was -4.25 diopters (D). Mean Snellen visual acuity dropped from 20/25 to 20/200 after the onset of hypotony.
Six of nine eyes recovered visual acuity to within one line of initial level after treatment of the hypotony. Four of these six eyes underwent resuturing of the scleral flap to reverse the excess filtration within 6 months of the onset of hypotony maculopathy. Five of these six patients had final vision of 20/30 or better. The mean phakic preoperative refractive error in these six eyes was -2.25 D, compared with a mean refractive error of -8.50 D in the three eyes with persistent visual loss (P = 0.002). After reversal of the hypotony, the average peak intraocular pressure in the six eyes with visual recovery was 33 mm Hg, compared with an average peak IOP of 7 mm Hg in the three eyes with persistent visual loss. (P = 0.015)
Although reversal of the hypotony maculopathy in six eyes was associated with a few weeks of higher than normal IOP, the final IOP was acceptably low. Five of six filtering blebs remained functional with a mean follow-up of 3 years. The final average IOP in the six eyes that were successfully treated was 12.7 mm Hg. In this series of patients, visual acuity was restored to eyes with hypotony maculopathy by increasing the IOP to higher than normal levels.
确定在小梁切除术后的眼中重新缝合巩膜瓣以提高眼压是否是治疗低眼压性黄斑病变的有效方法。
回顾了9例小梁切除术后因低眼压性黄斑病变导致视力丧失的连续患者的病历，以确定有助于视力成功恢复的因素。患者的平均年龄为50岁，平均屈光不正为-4.25屈光度（D）。低眼压发生后，平均斯内伦视力从20/25降至20/200。
9只眼中有6只在低眼压得到治疗后视力恢复到初始水平的一行以内。这6只眼中有4只在低眼压性黄斑病变发生后的6个月内进行了巩膜瓣重新缝合，以逆转过度滤过。这6名患者中有5名最终视力达到20/30或更好。这6只眼术前有晶状体的平均屈光不正为-2.25 D，而3只持续视力丧失的眼中平均屈光不正为-8.50 D（P = 0.002）。低眼压逆转后，视力恢复的6只眼中平均眼压峰值为33 mmHg，而3只持续视力丧失的眼中平均眼压峰值为7 mmHg（P = 0.015）。
虽然6只眼中低眼压性黄斑病变的逆转与几周高于正常水平的眼压有关，但最终眼压仍处于可接受的低水平。6个滤过泡中有5个在平均3年的随访中仍保持功能。成功治疗的6只眼中最终平均眼压为12.7 mmHg。在这组患者中，通过将眼压提高到高于正常水平，低眼压性黄斑病变患者的视力得以恢复。
