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Hypotonic maculopathy
Hypotonic maculopathy is a condition in which folds of the choroid and/or retina form with involvement of the macular area, leading to decreased vision against the background of hypotony. The probable mechanism of development is a contraction of the sclera. Maculopathy does not develop with hypotony in all cases, but more often in young patients with myopia and in patients with a significant decrease in intraocular pressure. This condition should be treated quickly, since there is a tendency for the process to become chronic. However, there are reports of successful treatment of patients after several years of the disease.
The best treatment is prevention, such as Palmberg's safe valve paracentesis. In addition, Palmberg described a technique for revision of the filtration pads using two sets of additional sutures to prevent maculopathy. The first set of two sutures regulates outflow from under the flap at an intraocular pressure of 8 to 12 mm Hg. The second set is applied at a pressure of 20 to 25 mm Hg. It is important to remember that donor tissue may be needed for flap revision.
Causes of changes in intraocular pressure and formation of a shallow anterior chamber
High intraocular pressure and a shallow chamber
- Aqueous humor outflow disorder syndrome (i.e. malignant glaucoma)
- Hemorrhage into the suprachoroidal space
- Pupillary block
Low intraocular pressure and shallow chamber
- Hyperfiltration with insufficient valve resistance
- Opoc in the uveoscleral tract due to choroidal detachment
- Cyclodialysis
- True shallow chamber with contact between the lens and the cornea or between the surface of the intraocular lens and the cornea (treatment should be started immediately)
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