Risk factors for ocular hypotony after XEN Gel Stent implantation.

PURPOSE: To investigate the incidence of postoperative hypotony, and risk factors for the development of hypotony in eyes who had undergone XEN Gel Stent implantation. METHODS: In this retrospective, single-centre case series, medical records of 170 consecutive eyes who had undergone XEN Gel Stent implantation with or without simultaneous phacoemulsification for primary or secondary open angle glaucoma were analysed. Primary outcome parameters were the incidence of postoperative hypotony and potential risk factors for its development, and secondary parameters were pre- and postoperative visual acuity, intraocular pressure (IOP), and number of IOP-lowering eye drops. RESULTS: Postoperative hypotony ≤ 6 mmHg occurred in 57% of eyes. Hypotony was without complications in 70.1%, 13.4% had transient complications with spontaneous resolution, and 16.5% had complications requiring treatment. Mean visual acuity logMAR before surgery accounted for 0.47 ± 0.46 in all eyes and 0.47 ± 0.48 at the 4-week visit. There was no significant difference of BCVA in the group of eyes with and without postoperative hypotony before and after surgery. The mean IOP before surgery was 24.6 ± 8.4 mmHg and decreased significantly to 18.4 ± 10.2 after 4 weeks. Eyes with an axial length over 24.3 mm had a threefold increased risk for postoperative hypotony (OR 3.226, 95% confidence interval 1.121-9.279). This risk was decreased in eyes with simultaneous cataract surgery (OR 0.483, 95% confidence interval 0.258-0.903). CONCLUSION: In our sample, postoperative hypotony was a common complication after XEN Gel Stent implantation, but serious, persistent complications were rare. A longer axial length predisposes the eye for the development of hypotony.

Analysis of risk factors and ocular hypotony characteristics in choroidal detachment after penetrating glaucoma surgery.

PURPOSE: To analyze the risk factors and ocular hypotony characteristics of choroidal detachment (CD) after penetrating glaucoma surgery and to compare between eyes with and without CD. METHODS: This retrospective study enrolled 173 eyes of 168 patients. Patients who underwent trabeculectomy or Ahmed glaucoma valve implantation due to medically uncontrolled glaucoma and who had intraocular pressure (IOP) < 9 mmHg at any time during the first postoperative week were included. RESULTS: The study population consisted of 61 (36.3%) females and 107 (63.7%) males with a mean age of 60.7 ± 14.2 years. The postoperative median follow-up time was 24 months (range, 12-40 months). Postoperatively, CD developed in 47 (27.1%) eyes. Multivariate analyses demonstrated that eyes with high preoperative IOP (> 40 mmHg) were 12.1 times more likely to develop CD (p = 0.000) and that presence of IOP < 9 mmHg on the first day of surgery increased the CD risk 3.8 times (p = 0.002); male gender raised the risk 2.7 times (p = 0.028). The mean preoperative IOP in CD eyes was significantly higher than in non-CD eyes (p = 0.000). The mean IOP change between preoperative and lowest IOP was significantly greater in those with CD than in those without CD (p = 0.000). The mean lowest IOP in the CD eyes was significantly lower than in the non-CD eyes (p = 0.037). For the surgical failure rate, no significant difference was found between the CD and the non-CD groups (p = 0.14). CONCLUSIONS: The present study demonstrated that high preoperative IOP, presence of IOP < 9 mmHg on the first postoperative day, and male gender were significantly associated with CD after penetrating glaucoma surgery. Choroidal detachment accompanied by hypotony did not affect the final outcome negatively.

Ocular Perfusion Pressure and the Risk of Open-Angle Glaucoma: Systematic Review and Meta-analysis.

Low ocular perfusion pressure (OPP) has been proposed as an important risk factor for glaucoma development and progression, but controversy still exists between studies. Therefore, we conducted a systematic review and meta-analysis to analyze the association between OPP and open-angle glaucoma (OAG). Studies were identified by searching PubMed and EMBASE databases. The pooled absolute and standardised mean difference in OPP between OAG patients and controls were evaluated using the random-effects model. Meta-regression analysis was conducted to investigate the factors associated with OPP difference between OAG patients and controls. A total of 43 studies were identified including 3,009 OAG patients, 369 patients with ocular hypertension, and 29,502 controls. The pooled absolute mean difference in OPP between OAG patients and controls was -2.52 mmHg (95% CI -4.06 to -0.98), meaning significantly lower OPP in OAG patients (P = 0.001). Subgroup analyses showed that OAG patients with baseline IOP > 21 mmHg (P = 0.019) and ocular hypertension patients also had significantly lower OPP than controls (P < 0.001), but such difference in OPP was not significant between OAG patients with baseline IOP of ≤21 mmHg and controls (P = 0.996). In conclusion, although no causal relationship was proven in the present study, our findings suggest that in patients with high baseline IOP, who already have a higher risk of glaucoma, low OPP might be another risk factor.

INCIDENCE AND RISK FACTORS FOR HYPOTONY AFTER 25-GAUGE PARS PLANA VITRECTOMY WITH NONEXPANSILE ENDOTAMPONADE.

PURPOSE: The purpose of this study was to assess the incidence and risk factors for early postoperative hypotony after 25-gauge pars plana vitrectomy with nonexpansile endotamponade. METHODS: A retrospective study of consecutive patients who underwent 25-G pars plana vitrectomy. Hypotony was defined as an intraocular pressure of 5 mmHg or less after surgery and ocular hypertension as an intraocular pressure greater than 21 mmHg. RESULTS: Overall, 307 eyes of 307 patients with a mean age of 61.7 ± 14.3 of which 56.7% were males were included. Hypotony was identified in 5.2% of cases (n = 16) at Day 1 and 0.7% (n = 2) at Week 1 with no hypotony-related complications. The hypotony group had a higher number of previous vitreoretinal surgeries (1.5 ± 1.1 vs. 0.4 ± 0.7, P < 0.001) and a higher prevalence of preoperative ocular hypertension (22.2% vs. 4.8%, P = 0.02), pseudophakia (77.8% vs. 48.4%, P = 0.01), silicone oil removal (61.1% vs. 8.3%, P < 0.001), and external diathermy performed (55.6% vs. 20.1%, P = 0.001). In stepwise multivariate analysis, significant parameters were silicone oil removal (R = 16.34%, odds ratio 13.45, P < 0.001), pseudophakia (R = 5.69%, odds ratio 3.65, P = 0.03), and younger age (R = 2.68%, odds ratio 0.96, P = 0.04). CONCLUSION: Silicone oil removal is a significant risk factor for early postoperative hypotony after 25-G pars plana vitrectomy.

Frequency of post-operative hypotony after 23-gauge transconjunctival vitrectomy with locally made instruments.

The objective of this study was to discern the frequency of post-operative hypotony after 23-gauge vitrectomy with locally made instruments. This study was conducted at the Department of Ophthalmology, Lahore General Hospital, Lahore from July 2012 to June 2016. A total of 300 patients underwent 23-gauge pars-plana vitrectomy. Locally made 23-gauge trocar cannula system was used in all the patients. Post-operative Intraocular Pressure(IOP) was measured using Goldman Applanation Tonometer on the first post-operative day. IOP of less than 06mmHg was termed as hypotonic. In our study, mean post-operative intraocular pressure was recorded as 8.32±3.04mmHg and frequency of post-operative hypotony after 23-guage vitrectomy with locally made instruments reveals 10.67% (n=32) while 89.33% (n=268) had no findings of hypotony. We concluded that the frequency of post-operative hypotony after 23-gauge vitrectomy with locally made instruments is slightly higher when compared with other studies and this instrument can be used for further surgeries.

Reconsidering the Postoperative Day 0 Visit for Retina Surgery.

BACKGROUND AND OBJECTIVE: This study compares outcomes of patients who were examined on postoperative (PO) day 0 and PO day 1 following retina surgery. PATIENTS AND METHODS: A nonrandomized, comparative, retrospective series of one vitreoretinal surgeon was conducted on 166 patients with a PO day 0 visit (approximately 5 hours following surgery) and 428 patients with a PO day 1 visit. RESULTS: Among patients examined at PO day 0, 4.6% had hypotony (intraocular pressure [IOP] ≤ 5 mm Hg) and 1.8% needed intervention for elevated IOP (IOP ≥ 30 mm Hg) compared with 1.6% and 4.0% of patients, respectively, examined on PO day 1. CONCLUSION: Following retina surgery, there is a similar percentage of patients with abnormal IOP when patients are examined on PO day 0 when compared with PO day 1. However, the rate of hypotony was statistically higher on PO day 0, and there was a trend toward more elevated IOP on PO day 1. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e52-e56.].

Exploring literature-based definitions of hypotony following glaucoma filtration surgery and the impact on clinical outcomes.

PURPOSE: To highlight the variations in published definitions of hypotony and their impact on reported clinical outcomes. To propose a revised definition, focusing on clinically significant hypotony (CH). METHODS: Literature review of hypotony definitions published between January 2010 and December 2015 was carried out. Numerical definitions for hypotony, its onset, duration and associated clinical signs were recorded. Each definition was applied to surgical outcomes data collected prospectively from a cohort of 300 glaucoma patients treated at a single centre. The sensitivity and specificity of each definition in identifying CH [defined as low intraocular pressure (IOP) with signs of maculopathy hypotony and choroidal detachment] were calculated. RESULTS: A total of 128 eligible papers were identified, and 14 different definitions for hypotony were extracted. In 53 (41.4%), hypotony was not defined. In the remaining 75 (58.6%), the numerical definitions varied between 4 and 8 mmHg, and of these, 24 (32%) included the onset and duration of hypotony as part of the definition. Definition-dependent hypotony rates within the cohort varied between 1% and 59.3%. No statistical differences were found between the groups based on corneal thickness or axial length. Clinically significant hypotony (CH) was identified in 37 (12.3%), with large differences in the sensitivity and specificity among published definition. CONCLUSION: Variations in defining postoperative hypotony can have a large impact on the reported success and failure rates among studies. There is a need for a more robust universal definition, focusing on clinically important signs, to allow better comparison between different treatment modalities.

Infusion Misdirection in Microincisional Vitrectomy Surgery.

PURPOSE: To review the incidence and possible mechanisms of 2 problems caused by infusion misdirection during microincisional vitrectomy in 1 physician's practice and to find an estimate of the broader occurrence among other physicians. DESIGN: Observational series of 1 surgeon's cases over 2 periods. A survey also was sent to other retinal specialists. PARTICIPANTS: Patients undergoing microincisional vitrectomy. METHODS: The physician tracked the occurrence of intraoperative hypotony and unintentional anterior chamber air infusion in his practice. A survey was sent to 2000 members of the American Society of Retina Specialists and the Retina Society. MAIN OUTCOME MEASURES: Primary outcome measure was the incidence of hypotony during microincisional vitrectomy, defined as softening of the globe to the point of corneal or scleral infolding, or both, that resolved with repositioning of the infusion cannula. The secondary outcome measure was incidence of unplanned air flow into the anterior chamber. Survey questions included frequency of observed infusion interruption and incidence of inadvertent anterior chamber air infusion. RESULTS: In the earlier series, of 232 vitrectomies, 37 (16%) showed signs of episodic hypotony after infusion blockage. Seven cases (3%) showed inadvertent air flow into the anterior chamber. One hundred fifty-two physicians responded to the survey. Fifty-seven percent reported infusion blockage and hypotony in 1% to 5% of cases. Fifty-nine percent reported air flow into the anterior chamber in some cases. In the later series, 12 instances of infusion blockage were noted in 118 cases. Awareness of the issue and additional attention to the infusion line taping did not prevent the problem from occurring. In the survey, most respondents reported observing both infusion interruption and inadvertent anterior chamber air infusion on occasion. CONCLUSIONS: Infusion misdirection resulting in hypotony or air flow into the anterior chamber seems to be infrequent, but it remains a risk. Awareness of the problem reduces the incidence, but does not eliminate it. The potential inadvertently to touch the retina, choroid, or lens increases when these events occur. Infusion misdirection can be avoided by maintaining the correct position of the cannula, which may be facilitated by an external support to the tubing.

Pattern of Uveitic Hypotony in a Tertiary Eye Hospital in India.

PURPOSE: To report pattern of uveitic patients with hypotony in Indian population. METHODS: Retrospective medical record review of 30 eyes of 21 consecutive patients with uveitic hypotony. Patient demographics, ocular findings and systemic association were recorded. RESULTS: Mean age of the patients was 29.5 years (range 7-71 years) and 80.9%(17 patients) were below the age of 40 years. Most common complaint associated with the development of hypotony was diminution of vision (26 eyes; 86.6%), and cells in anterior vitreous (25 eyes, 83.3%) were the most common slit-lamp finding. Most common type of ocular inflammation causing hypotony was panuveitis (14, 46.6%), and ocular tuberculosis (5; 23.8%) was the most common cause of uveitis in these patients. CONCLUSION: Ocular hypotony is a rare but dreaded complication of uveitis. The etiology of uveitic hypotony is not uniform across the world, and tuberculosis remains an important cause of uveitic hypotony in tuberculosis endemic country like India.

Glaucoma drainage device surgery in children and adults: a comparative study of outcomes and complications.

PURPOSE: To compare the postoperative outcomes and complications of glaucoma drainage device (GDD) surgery in pediatric (<18 years old) and adult patients. METHODS: Retrospective, comparative study including all patients who underwent Baervedlt or Molteno device surgery by the same surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and 21 mmHg and a 20% reduction from baseline. RESULTS: Fifty-two children (69 eyes) and 130 adults (145 eyes) were included. Mean IOP and number of medications were significantly reduced postoperatively in both groups. Overall failure rate was similar in children and adults. However, GDD failed earlier in adults than in children. Hypotony was the most common complication in both groups in the first 6 months postoperatively. Later on, bleb encapsulation was more frequent in children, while corneal decompensation tended to be more frequent and occurred earlier in adults. Children also had a higher rate of infectious endophthalmitis and required tube repositioning more frequently than adults. CONCLUSIONS: GDD surgery presents different postoperative challenges in children and adults, and the surgeon should remain vigilant for complications throughout the postoperative period, especially for signs of endophthalmitis or bleb encapsulation in pediatric patients. On the other hand, adults may be more prone to early corneal decompensation.

Ocular Hypotony in Patients With Juvenile Idiopathic Arthritis-Associated Uveitis.

PURPOSE: To analyze occurrence, risk factors, and course of ocular hypotony (OH) in juvenile idiopathic arthritis-associated uveitis (JIAU). DESIGN: Cohort study. METHODS: Epidemiologic and ophthalmologic data at baseline and during follow-up of JIAU patients with and without ocular hypotony were evaluated. RESULTS: OH developed in 57 of the 365 JIAU patients during the follow-up (mean 4.5 ± 3.5 years). In 40 patients with follow-up ≥12 months, OH was unrelated to previous ocular surgery: risk factors at baseline (univariate logistic regression analysis) included longer total duration of uveitis (odds ratio [OR] 1.13, P < .001), bilateral uveitis (OR 3.51, P = .009), low visual acuity (OR 5.1, P = .001), high laser-flare (LF) values (OR 1.74, P = .01), and presence of posterior synechiae (OR 3.28, P = .004). Increased anterior chamber (AC) cell and LF values were observed within 3 months prior to onset of transient (≤3 months; 37.5%) or persistent OH (>3 months; 62.5%). AC cell and LF values decreased within 3 months after onset of transient OH, while LF levels remained elevated ≥12 months in persistent OH. Optic disc edema and epiretinal membrane formation was found more frequently after OH onset. CONCLUSIONS: OH was observed in 15.6% of JIAU patients. Longer total uveitis duration, bilateral uveitis, low visual acuity, high AC flare and LF grades, and presence of posterior synechiae at baseline were risk factors for subsequent OH. Burden of OH might be improved with immunosuppression.

Risk of Hypotony in Juvenile Idiopathic Arthritis-Associated Uveitis.

OBJECTIVE: To describe risk factors for hypotony in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN: Retrospective cohort study. METHODS: All patients with JIA-associated uveitis (N = 108; affected eyes = 196) evaluated and followed at the Wilmer Eye Institute from July 1984 through June 2014 were included in this study. Prevalence and incidence of hypotony (intraocular pressure [IOP] <5 mm Hg) and low IOP (5 mm Hg ≤ IOP < 8 mm Hg) and risk factors for developing hypotony were analyzed. RESULTS: At presentation, 9.3% of patients (7.1% of affected eyes) had hypotony. During a median follow-up of 5.3 years, the rate of developing hypotony and low IOP were 0.04 per eye-year (/EY; 95% confidence interval [CI]: 0.02/EY, 0.05/EY) and 0.06/EY (95% CI: 0.04/EY, 0.08/EY), respectively. Risk factors for development of hypotony during follow-up appeared to be associated with more severe uveitic disease, such as the presence of panuveitis (adjusted hazard ratio [aHR], 43.1; P = .004), anterior chamber cells or flare ≥ 3+ (aHR, 25.6, P < .001), posterior synechiae (aHR, 5.9, P = .02), and the use of oral corticosteroid (aHR 28.9; P = .003) at the presenting examination. Receiving immunosuppressive drug therapy at the time of presentation was associated with a lower risk of development of hypotony (aHR, 0.02; P = .002). CONCLUSIONS: Hypotony affects a small but significant proportion of patients with JIA-associated uveitis and is associated with signs of active and severe uveitis. Immunosuppression was associated with significantly lower risk of hypotony, suggesting that aggressive control of the inflammation may reduce risk of hypotony in JIA-associated uveitis.

Persistent hypotony after trabeculectomy: incidence and associated factors in the Collaborative Bleb-Related Infection Incidence and Treatment Study.

PURPOSE: To investigate the incidence of and factors associated with persistent hypotony after trabeculectomy with mitomycin C in the Collaborative Bleb-Related Infection Incidence and Treatment Study (CBIITS), a 5-year prospective multicenter study. METHODS: A total of 955 eyes of 955 patients who underwent trabeculectomy with mitomycin C were studied. Surgical failure was defined as insufficient intraocular pressure (IOP) reduction (IOP > 21 mmHg or <20 % IOP reduction, or further glaucoma surgeries), loss of light perception, or persistent hypotony (IOP ≤ 5 mmHg persisting for >6 months). Factors associated with persistent hypotony in eyes with sufficient IOP reduction were determined by survival analysis and logistic regression analysis. RESULTS: The cumulative probabilities of surgical success and persistent hypotony at 5 years were 62.0 ± 1.7 % (±standard error) and 7.7 ± 0.9 %, respectively. In 685 eyes with sufficient IOP reduction, preoperative IOP (mmHg), limbus-based conjunctival flap, or choroidal detachment that occurred within 6 months of the surgery were significant risk factors for persistent hypotony [Cox proportional hazards regression model: hazard ratio, 0.95, 2.27, 3.24; 95 % confidence interval (CI), 0.91-0.98, 1.21-4.23, 1.51-6.95; P = 0.005, 0.01, 0.003, respectively]. Bleb infection and final visual acuity (logarithm of the minimal angle of resolution) were significantly associated with persistent hypotony (logistic regression: odds ratio, 8.74, 1.37; 95 % CI, 1.89-40.4, 1.03-1.82; P = 0.006, 0.029, respectively). CONCLUSIONS: In the CBIITS, eyes with successful IOP reduction, a limbus-based conjunctival flap, lower preoperative IOP, and choroidal detachment that occurred within 6 months of the surgery were identified as risk factors for persistent hypotony.

Previous cyclodestruction is a risk factor for late-onset hypotony and suprachoroidal haemorrhage after glaucoma drainage device surgery.

AIM: To investigate whether previous cyclodestructive (eg, cyclophotocoagulation and cyclocryodestruction) procedures have any influence on the general outcome and pressure level after glaucoma drainage device (GDD) surgery. METHODS: Retrospective analysis of 110 consecutive patients who had undergone GDD (Baerveldt 250 mm(2) and 350 mm(2) implant, AMO, USA) surgery with a minimum follow-up of 3 months. The patients were divided into patients with previous cyclodestructive surgery before GDD surgery (I; 47 patients) and patients without previous cyclodestructive surgery (II; 63 patients). Intraocular pressure (IOP), medication score, best-corrected visual acuity and surgical treatments were recorded before and after drainage device implantation. RESULTS: Patients of group I had a mean preoperative IOP of 32.1 mm Hg and a mean medication score of 4.8; patients of group II had a mean preoperative IOP of 29.2 mm Hg (p=0.18) and a mean medication score of 4.9 (p=0.84). All patients who developed suprachoroidal haemorrhage (six cases) belonged to group I (6/47=12.8%), no patient of group II (0/63=0%) developed suprachoroidal haemorrhage (Fisher's test: p=0.01). Twelve patients developed late-onset (>6 weeks after GDD surgery) hypotony, nine of them belonging to group I (9/47=19.1%) and three of them to group II (3/63=4.8%) (Fisher's test: p=0.03). CONCLUSIONS: While taking potential bias arising from the retrospective nature of the study into consideration, a history of previous cyclodestructive procedures before GDD surgery seems to be a major risk factor for suprachoroidal haemorrhage and for late-onset postoperative hypotony.

Incidence of hypotony and sympathetic ophthalmia following trans-scleral cyclophotocoagulation for glaucoma and a report of risk factors.

OBJECTIVE: To report the incidence and risk factors for hypotony and estimate the risk of sympathetic ophthalmia following diode laser trans-scleral cyclophotocoagulation (TSCPC). DESIGN: Retrospective study using data from a private tertiary glaucoma clinic and review of the literature. PARTICIPANTS: Seventy eyes of 70 patients with refractory glaucoma who received TSCPC treatment. METHODS: Review of the records of consecutive patients who underwent TSCPC by a single ophthalmic surgeon and review of the literature. MAIN OUTCOME MEASURES: Hypotony (including phthisis bulbi), sympathetic ophthalmia. RESULTS: Seven eyes (10%; CI 5-19%) developed hypotony and included 4 eyes that developed phthisis. Higher total energy delivered during TSCPC treatment was associated with an increased risk of hypotony: eyes that developed hypotony received a mean total energy of 192.5 ± 73.2 joules, compared to a mean of 152.9 ± 83.2 joules in hypotony-free cases. The risk of sympathetic ophthalmia estimated from a review of the published literature and current series was one in 1512, or 0.07% (CI 0.03%-0.17%). CONCLUSIONS: Total laser energy is one of several risk factors that act in a sufficient component cause-model to produce hypotony in an individual patient. The small sample size precluded inference for other individual putative risk factors but titrating laser energy may help decrease the occurrence of hypotony. The risk of sympathetic ophthalmia calculated from the literature is likely an overestimate caused by publication bias.

Risk of hypotony in noninfectious uveitis.

OBJECTIVE: We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with noninfectious uveitis seen between 1979 and 2007 at 4 academic ocular inflammation specialty clinics. METHODS: Data were collected from medical records by trained, certified, expert reviewers. MAIN OUTCOME MEASURES: Hypotony (<5 mmHg) and low intraocular pressure (<8 mmHg), each sustained for ≥ 2 visits spanning ≥ 30 days. RESULTS: During follow-up, 126 of 6785 patients (1.86%) developed hypotony at the rate of 0.61% (95% confidence interval [CI], 0.50-0.75%) per eye-year. Cataract surgery was associated with a 7.5-fold risk (adjusted hazard ratio [aHR], 7.51; 95% CI, 3.97-14.23) of incident hypotony. Phacoemulsification, the type of cataract surgery associated with the least hypotony risk still was associated with nearly 5-fold higher hypotony incidence (aHR, 4.87; 95% CI, 2.25-10.55). Increased risk was observed in children (aHR, 2.92; 95% CI, 1.20-7.10) with respect to young adults, and duration of uveitis of >5 years (aHR, 3.08; 95% CI, 1.30-7.31) with respect to uveitis of <6 month duration. Band keratopathy, ≥ 3+ vitreous cells, exudative retinal detachment, posterior synechia, and a history of pars plana vitrectomy also were associated with greater hypotony incidence. With respect to anterior uveitis, intermediate uveitis (aHR, 0.17; 95% CI, 0.05-0.56) and posterior uveitis (aHR, 0.11; 95% CI, 0.03-0.45) were associated with lower hypotony risk, whereas panuveitis (aHR, 1.25; 95% CI, 0.67-2.35) was similar. Approximately five-sixths (84.1%) of eyes presenting with hypotony had a visual acuity of ≤ 20/200 (aOR for visual acuity ≤ 20/200, 13.85; 95% CI, 7.23-26.53). Risk factors for prevalent hypotony were similar. CONCLUSIONS: The risk of hypotony is low among eyes with noninfectious uveitis, but is more frequently observed in cases with anterior segment inflammation. Signs of present or past inflammation were associated with greater risk, suggesting excellent inflammatory control may reduce the risk of hypotony. Prior ocular surgery also was associated with higher risk; cataract surgery in particular was associated with much higher risk of hypotony. Lower risk of hypotony with phacoemulsification than with alternative cataract surgery approaches suggests the phacoemulsification approach is preferable.

Hypotony in patients with uveitis: The Multicenter Uveitis Steroid Treatment (MUST) Trial.

PURPOSE: To assess the prevalence of hypotony in patients with severe forms of uveitis. METHODS: The Multicenter Uveitis Steroid Treatment (MUST) Trial, a randomized study, enrolled 255 patients. Patients with hypotony at the baseline visit were identified. RESULTS: Twenty (8.3%) of 240 patients with sufficient data had hypotony. Hypotony was more common in patients with uveitis ≥5 years duration (odds ratio [OR] = 5.0; p < .01), and in eyes with a history of ocular surgery (vitrectomy vs. none, OR = 3.1; p = .03). Hypotony was less in patients with older age of uveitis onset (>51 years vs. <51 years, OR = 0.1; p = .02), in Caucasian patients (OR = 0.1; p < .01) compared to African American patients. Hypotonous eyes were more likely to have visual impairment (OR = 22.9; p < .01). CONCLUSIONS: Hypotony is an important complication of uveitis and more commonly affects African-American patients, those with uveitis onset at a younger age, and those with longer disease duration. It is associated with visual impairment.

Incidence of postoperative hypotony in 25-gauge vitrectomy: oblique versus straight sclerotomies.

OBJECTIVE: To compare the incidence of hypotony after oblique and straight sclerotomies in 25-gauge transconjunctival sutureless vitrectomy (TSV). DESIGN: Retrospective, comparative, interventional case series. PARTICIPANTS: Two hundred seventy-five eyes of 250 patients. METHODS: We reviewed 275 consecutive cases of 25-gauge TSV. Oblique incisions were performed on 141 eyes and straight incisions on 134 eyes. RESULTS: On postoperative day 1, there was no significant difference in the incidence of hypotony (9.9% vs. 9.2%; p = 0.85) between oblique and straight incisions. The type of incision showed no statistical effect on hypotony in eyes filled with fluid (p = 0.91) or air-gas (p = 0.81). Hypotony was significantly reduced using air-gas endotamponade (4.8%) as compared to fluid-filled eyes (20.0%; p = 0.0001). CONCLUSION: Oblique incisions do not reduce the incidence of postoperative hypotony in fluid-filled eyes or with air-gas tamponade. Air-gas tamponade use results in a 4-fold reduction in the incidence of hypotony.

[Viscocanalostomy: preliminary clinical results]. / Viscocanalostomie: résultats cliniques à court terme.

PURPOSE: Filtration surgery has shifted in the past 20 years to a nonperforating surgery to reduce complications. The purpose of this study was to assess the short-term clinical results and complications of viscocanalostomy. PATIENT AND METHODS: In a prospective and nonrandomized study, 107 consecutive eyes of 67 patients who underwent viscocanalostomy were analyzed. The surgeon conducted postoperative care. The minimal follow-up was 1 year, with a mean follow-up of 13.1 months (range, 12-18 months). The criteria for success were defined as intraocular pressure (IOP) less than 21 mmHg without treatment. RESULTS: The mean preoperative intraocular pressure was 28.3 mmHg while the mean postoperative intraocular pressure was 5.4 mmHg on the first day and 10.2 mmHg at 13 months. The rate of patients who had intraocular pressure below 21 mmHg with or without treatment was 98% at 13 months. The complete success rate without treatment was 80% at 13 months. Seven cases of ocular hypotony lasting more than 1 month were noted. CONCLUSION: Viscocanalostomy is a promising procedure because in the short term it provides good tonometric results in glaucomatous patients without the complications of trabeculectomy. However, it remains a technique with a learning curve.

Ocular hypotension and hypotony in multibacillary leprosy patients; at diagnosis, during and after completion of multidrug therapy.

The prevalence and incidence of ocular hypotony (IOP < 7 mm Hg) and factors associated with them were determined in a Leprosy Referral Centre at Tamilnadu, India. Applanation intraocular pressures were measured every six months in a cohort of newly diagnosed multibacillary (MB) leprosy patients who were followed-up during the two year period of multidrug therapy (MDT) and for five years thereafter. Transient hypotony was present in two patients at the time of diagnosis, in 3 patients during MDT and in 9 patients after MDT with a cumulative prevalence of 4.65%. Transient ocular hypotension was present in 24 patients (8%) at disease diagnosis. 25 patients developed hypotension during MDT that was associated with trichiasis (HR 8.83 95% CI 2.06, 37.78 p = 0.003) and flare or/and cells (HR 4.60 95% CI 1.08, 19.64 p = 0.039). 29 patients developed ocular hypotension after MDT that was associated with punctate keratitis and uveal involvement. In general, MB leprosy patients with hypotension had a mean IOP of 12.60 mm Hg which differed significantly (p < 0.0001) from the mean IOP of 14.9 mm Hg in those who did not have hypotension. Transient hypotension and hypotony in MB leprosy patients are associated with signs of intraocular inflammation.