J Glaucoma. 2021 Jun 10. doi: 10.1097/IJG.0000000000001882. Online ahead of print.
ABSTRACT
PRECIS: Chronic hypotony is not uncommon following deep sclerectomy, but only a minor proportion of patients develop hypotony-associated complications. Numerical hypotony does not affect the visual outcomes. This study identifies factors associated with hypotony.
PURPOSE: To investigate the incidence and risk factors of hypotony and hypotony-associated complications after deep sclerectomy (DS).
METHODS: Retrospective cohort study of 1,765 eyes (1,385 patients) undergoing DS with or without cataract extraction between 2001-2020 in two UK centers. Chronic hypotony was defined as intraocular pressure (IOP) ≤5▒mmHg in ≥2 consecutive visits lasting >90 days or as any IOP≤5▒mmHg associated with hypotony-related complications or requiring surgical intervention. Clinical hypotony was defined as the presence of: serous or hemorrhagic choroidal detachment, hypotony maculopathy, flat anterior chamber requiring reformation, decompression retinopathy. The incidence of hypotony was calculated with Kaplan-Meier statistics, and Cox regression was used to identify risk factors.
RESULTS: The median (IQR) age and follow-up were 76 (67-82) years and 45.4 (20.9-79.8) months, respectively. The incidence (95% CI) of chronic and clinical hypotony at 5 years was 13.4% (11.5-15.3%) and 5.6% (4.3-6.9%) respectively. Sixteen eyes (15.7%) with hypotony-associated complications had IOP >5▒mmHg. Male gender (HR:1.89, P=0.018), non-Caucasian ethnicity (HR:2.49, P=0.046), intraoperative bevacizumab (HR:3.96, P=0.01), pigmentary glaucoma (HR:3.59, P=0.048), previous vitreoretinal surgery (HR:5.70, P=0.009), intraoperative microperforation (HR:4.17, P<0.001) and macroperforation (HR:20.759, P<0.001), and avascular bleb (HR:1.80, P=0.036) were associated with clinical hypotony.
DISCUSSION: Chronic hypotony is not uncommon following DS, but clinical hypotony is infrequent. Hypotony associated-complications can occur in eyes without statistical hypotony.
PMID:34115726 | DOI:10.1097/IJG.0000000000001882
