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    Eyes with hypotony may fail less often after trabeculectomy

    San Francisco—Eyes with hypotony after trabeculectomy might fare better than those without hypotony, a new study shows. 

    If supported by further studies, the finding could change the way surgeons look at low IOP in glaucoma surgery, said Anne Coleman, MD, PhD, during the Shaffer-Hetherington-Hoskins Lecture at the 2016 Glaucoma 360 meeting.

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    “We automatically say if you have a pressure of less than 5 [mm Hg] or less than 6 [mm Hg], you’re a failure,” said Dr. Coleman, director, Jules Stein Eye Institute Center for Community Outreach, University of California, Los Angeles. “Our results are showing that might not be the case—you might do at least as well as people who don’t have hypotony, maybe a little bit better.”

    The definition of hypotony varies, with some authorities using an IOP of less than 6.5 mm Hg, and others at most 5 mm Hg.

    In trials, investigators have measured the incidence at follow-up times of varying lengths after trabeculectomy. Partly as a consequence, incidence rates have ranged from 7.2% to 42.2% in observational studies and 1.6% to 12.4% in trabeculectomy clinical trials, Dr. Coleman said.

    More: Managing functional visual field loss with low IOP

    Potential causes include overfiltration after trabeculectomy, bleb leaks, and decreased aqueous production by the ciliary body.

    Anne Coleman, MD, PhD speaks with Ophthalmology Times at Glaucoma 360.

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    • With all the potential complications from hypotony, I just have a hard time to believe trab with hypotony can be considered as a success.

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