Postfiltration hypotony maculopathy in young chinese myopic women with glaucomatous appearing optic neuropathy.

PURPOSE: To describe management and surgical outcomes of 3 young women of Chinese origin with advanced glaucomatous optic neuropathy.

PATIENTS: Three 36 to 48-year-old female patients.

METHODS

A retrospective medical records review of 3 Chinese women with prior diagnoses of glaucoma treated with trabeculectomy was performed. Optic nerve imaging and standard automated perimetry were also reviewed. Mean follow-up period was 4 years.

RESULTS

All patients had arcuate scotomas bilaterally at the time of initial ophthalmic examination. Two patients were highly myopic (>or= -6.00 diopter spherical equivalent) with tilting of the optic nerve head and parapapillary atrophy. Cup-to-disc ratios ranged from 0.4 to 0.9. Trabeculectomy with mitomycin C was performed in the right eye of all patients with subsequent hypotony related complications requiring surgical treatment. All patients experienced long-term decline in best-corrected visual acuity after trabeculectomy. No patient had a new area of field loss on standard automated perimetry, although the density of the preexisting scotomas increased in the nonoperated eye of all patients.

CONCLUSIONS

High myopia, optic nerve head tilting, and parapapillary atrophy are likely associated with the increased susceptibility to damage of dependent axons. Axons outside of the area of tilt may be relatively protected. As young myopes are more likely to suffer from hypotony related complications after trabeculectomy, the risk of an increase in preexisting field defect density should be weighed against the risk of long-term vision loss after filtration surgery. The development of a new area of field loss may be an appropriate indication for surgery in some such patients.