Hypotony maculopathy
{{Short description|Disease of the eye}}
{{Infobox medical condition (new)
| name = Hypotony maculopathy
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| field = Ophthalmology,
| symptoms = blurry vision, vision loss
| complications = Blindness
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| causes = Low intraocular pressure
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| diagnosis = Eye examination
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Hypotony maculopathy is maculopathy due to very low intraocular pressure known as ocular hypotony. Maculopathy occurs either due to increased outflow of aqueous humor through angle of anterior chamber or less commonly, due to decreased aqueous humor secretion by ciliary body.
Description
Hypotony maculopathy is maculopathy due to ocular hypotony.{{Cite web |title=Hypotony Maculopathy - EyeWiki |url=https://eyewiki.aao.org/Hypotony_Maculopathy |access-date=2022-04-13 |website=eyewiki.aao.org}} Fundus examination may reveal abnormalities like chorioretinal folds, optic nerve head swelling (papilledema) and tortuosity of blood vessels.
Causes
Maculopathy occurs either due to increased outflow of aqueous humor through angle of anterior chamber or less commonly, due to decreased aqueous humor secretion by ciliary body.{{Cite web |date=2009-10-01 |title=Assessing and Managing Hypotony Maculopathy |url=https://www.aao.org/eyenet/article/assessing-managing-hypotony-maculopathy |access-date=2022-04-14 |website=American Academy of Ophthalmology |language=en}}
Chronic inflammation within the eye including iridocyclitis, medications including anti glaucoma drugs, or proliferative vitreoretinopathy causes decreased production.{{cite journal |last1=Fine |first1=Howard F. |last2=Biscette |first2=O'neil |last3=Chang |first3=Stanley |last4=Schiff |first4=William M. |title=Ocular hypotony: a review |journal=Comprehensive Ophthalmology Update |date=January 2007 |volume=8 |issue=1 |pages=29–37 |pmid=17394757 |url=https://pubmed.ncbi.nlm.nih.gov/17394757/ |issn=1527-7313}}{{cite web |title=Ocular Hypotony: Background, Pathophysiology, Epidemiology |url=https://emedicine.medscape.com/article/1207657-overview |date=19 July 2021}} Increased outflow or aqueous loss may occur following a glaucoma surgery, trauma, post-surgical wound leak from the eye, cyclodialysis cleft, tractional ciliary body detachment or retinal detachment. Use of anti fibrosis drugs like mitomycin C during glaucoma surgery will increase the risk of hypotony maculopathy development.
Investigations
Many ophthalmic imaging techniques are used in detecting hypotony maculopathy. Indocyanine green angiography or fluorescein angiography can help in early detection of choroidal disturbances and choroidal folds.{{Cite journal |last1=Masaoka |first1=N. |last2=Sawada |first2=K. |last3=Komatsu |first3=T. |last4=Fukushima |first4=A. |last5=Ueno |first5=H. |date=May 2000 |title=Indocyanine green angiographic findings in 3 patients with traumatic hypotony maculopathy |url=https://pubmed.ncbi.nlm.nih.gov/10913648/ |journal=Japanese Journal of Ophthalmology |volume=44 |issue=3 |pages=283–289 |doi=10.1016/s0021-5155(99)00222-1 |issn=0021-5155 |pmid=10913648}} Medical ultrasound may be used to detect scleral and choroidal thickening, anterior chamber depth, ciliary detachment and cyclodialysis cleft. OCT scanning can be used in detecting abnormalities of retina and choroid.{{Cite journal |last1=Budenz |first1=Donald L. |last2=Schwartz |first2=Kenneth |last3=Gedde |first3=Steven J. |date=2005-01-01 |title=Occult Hypotony Maculopathy Diagnosed With Optical Coherence Tomography |journal=Archives of Ophthalmology |volume=123 |issue=1 |pages=113–114 |doi=10.1001/archopht.123.1.113 |pmid=15642824 |issn=0003-9950|doi-access=free }}
Treatment
To prevent retinal dysfunction and vision loss, intraocular pressure should be normalised by treating the cause of hypotony.{{Cite journal |last1=Lee |first1=Yun Jeong |last2=Woo |first2=Se Joon |date=2021-05-07 |title=Hypotony maculopathy and photoreceptor folds with disruptions after vitrectomy for epiretinal membrane removal: two case reports |journal=Journal of Medical Case Reports |volume=15 |issue=1 |pages=255 |doi=10.1186/s13256-021-02824-3 |pmid=33957968 |pmc=8103759 |issn=1752-1947 |doi-access=free }} Delay in treatment results in permanent chorioretinal changes and permanent loss of vision.
History
Dellaporta first described the condition in 1954.{{Cite journal |last1=Costa |first1=Vital Paulino |last2=Arcieri |first2=Enyr Saran |date= September 2007 |title=Hypotony maculopathy |journal=Acta Ophthalmologica Scandinavica |volume=85 |issue=6 |pages=586–597 |doi=10.1111/j.1600-0420.2007.00910.x |issn=1395-3907 |pmid=17542978|doi-access=free }} Gass, in 1972, named it hypotony maculopathy.{{Cite web |title=Hypotony Maculopathy After Phacoemulsification |url=https://retinatoday.com/articles/2020-mar/hypotony-maculopathy-after-phacoemulsification |access-date=2022-04-14 |website=Retina Today |language=en}}