Recurrent macular neurosensory detachment in hypotony maculopathy managed with topical corticosteroids

• Published in: BMJ case reports 2022-06, Vol.15 (6), p.e248773
• Main Authors: Barbosa, Renato Correia, Bastos, Ricardo, Tenedório, Paula
• Format: Article
• Language: English
• Subjects: Case reports; Case Reports: Learning from unexpected outcome (positive or negative); Dexamethasone - therapeutic use; Eye surgery; Female; Glaucoma; Glaucoma - surgery; Humans; Intraocular Pressure; Macular Degeneration - complications; Ocular Hypotension - drug therapy; Ocular Hypotension - etiology; Retinal detachment; Retinal Diseases - etiology; Steroids; Tomography; Trabeculectomy - adverse effects
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2022-248773

A female patient in her late 70s underwent uncomplicated non-penetrating deep sclerectomy surgery. Three years after surgery, she presented with a sudden decrease in visual acuity, intraocular pressure (IOP) of 2 mmHg, macular folding and significant macular subretinal fluid. Assuming hypotony as the cause, topical dexamethasone was started, with complete functional and imagological improvement. Two months after withdrawal, she returned with the same symptoms and imagological findings. The same topical treatment was re-established, with progressive and complete improvement. After 14 months of follow-up and a maintenance dose of topical dexamethasone (1id), the patient remained stable with an IOP of 16 mm Hg. Hypotony maculopathy can, in rare cases, lead to subretinal fluid and neurosensory detachment. Topical corticosteroids can reverse and prevent hypotony in patients who are corticosteroid responsive. In advanced glaucoma, extremely low IOP may be as dangerous as high IOP. Timely normalisation of IOP may restore normal retinal architecture with associated functional improvement.