Journal of Current Glaucoma Practice

Register      Login

VOLUME 11 , ISSUE 2 ( May-August, 2017 ) > List of Articles


Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors

Ana Luiza B Scoralick, Izabela Almeida, Michele Ushida, Diego T Dias, Tiago S Prata, Fábio N Kanadani

Citation Information : Scoralick AL, Almeida I, Ushida M, Dias DT, Prata TS, Kanadani FN. Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017; 11 (2):58-62.

DOI: 10.5005/jp-journals-10028-1224

License: CC BY 3.0

Published Online: 01-01-2015

Copyright Statement:  Copyright © 2017; The Author(s).



To investigate surgical outcomes and success predictors of transconjunctival scleral flap resuturing for the management of hypotony due to overfiltration following trabeculectomy with mitomycin C.

Materials and methods

Noncomparative, retrospective, interventional case series in which all glaucoma patients from two glaucoma services undergoing transconjunctival scleral flap resuturing between May 2012 and July 2016 were enrolled. Included eyes had to have hypotony [intraocular pressure (IOP) ≤ 6 mm Hg] and/or hypotony maculopathy caused by excessive filtration following trabeculectomy. Key exclusion criteria were wound/bleb leaking and postoperative ocular trauma or infection. Preoperative and postoperative IOP, best-corrected visual acuity (BCVA), fundus imaging, surgical complications, and any subsequent related events or procedures were recorded. Rates of postsurgical hypotony and/or maculopathy resolution and possible success predictors were investigated.


A total of 22 patients (22 eyes) with a mean age of 56.4 ± 15.2 years were included. Median follow-up was 245 days [interquartilerange (IR); 120–817 days] and mean IOP was increased from 2.9 ± 1.5 mm Hg (1–6 mm Hg) to 8.5 ± 3.1 mm Hg (2–16 mm Hg) at the last follow-up visit (p < 0.01). Approximately 75% of the cases (16 out of 22) had an IOP between 7 and 18 mm Hg at the end of the follow-up period. Median BCVA (log MAR) at last follow-up visit [0.1 (IR; 0.0- 0.3)] was significantly better than preoperative BCVA [0.4 (IR; 0.1-1.0); p < 0.01]. Hypotony resolved in 81% of the cases, while maculopathy resolution was found in 85% of the cases. Time interval between trabeculectomy and flap resuturing was the only factor significantly associated with patient's IOP at last follow-up visit (R2 = 0.23; p = 0.036). Success rates (IOP < 6 mm Hg at last follow-up visit) were halved in those left untreated for more than 6 months. No serious adverse event was recorded.


Our findings support the use of transconjunctival scleral flap resuturing as an effective and safe alternative for hypotony management due to overflitration following trabeculectomy. As time interval seems to influence the odds of hypotony resolution, early intervention is recommended.

How to cite this article

Scoralick ALB, Almeida I, Ushida M, Dias DT, Dorairaj S, Prata TS, Kanadani FN, Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017;11(2):58-62.

  1. Shields Textbook of Glaucoma. 6th edition. Philadelphia, USA: Lippincott Williams & Wilkins; 2011.
  2. Hypotony maculopathy following the use of topical mitomycin C in glaucoma filtration surgery. Ophthalmic Surg 1993 Jun;24(6):389-394.
  3. Hypotony maculopathy after filtering surgery with mitomycin C. Incidence and treatment. Ophthalmology. 1997 Feb;104(2):207-214.
  4. Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous. Surv Ophthalmol 1996 Sept-Oct;41(2):97-125.
  5. Stabilization of flat anterior chamber after trabeculectomy with Healon5. J Cataract Refract Surg 2002 Apr;28(4):712-714.
  6. Hypotony and choroidal detachment as late complications of trabeculectomy. Am J Ophthalmol 1987 May;103(5):685-688.
  7. Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin C. Am J Ophthalmol 1993 Dec;116(6):673-683.
  8. Hypotonic maculopathy after trabeculectomy with postoperative use of 5-fluorouracil. Ophthalmologica. 1994;208(6):318-320.
  9. Development of cataract after trabeculectomy. Acta Ophthalmol (Copenh). 1993 Dec;71(6):777-781.
  10. Hypotony maculopathy. Acta Ophthalmol Scand. 2007 Sept;85(6):586-597.
  11. Ocular hypotony. In: Ritch R, Krupin T, Shields MB, editors. The glaucomas. 2. St. Louis: Mosby; 1996. pp. 385-395.
  12. Hypotony after glaucoma filtration surgery. Int Ophthalmol Clin 2000;40(1):127-136.
  13. . Macular changes detected by Fourier-domain optical coherence tomography in patients with hypotony without clinical maculopathy. Acta Ophthalmol. 2011;89(3):e274-e277.
  14. Hypotony maculopathy. In: Bellows JC, editor. Contemporary ophthalmology, honoring Sir Steward Duke-Elder. Baltimore: Williams and Wilkins; 1972. pp. 343-366.
  15. Treatment of hypotonous maculopathy after trabeculectomy with mitomycin C. Am J Ophthalmol. 1994 Sept;118(3):322-331.
  16. Treatment of chronic postfiltration hypotony by intrableb injection of autologous blood. Arch Ophthalmol. 1993;111(6):827-830.
  17. Cryosurgical closure of filtering blebs. Arch Ophthalmol 1972 Mar;87(3):319-323.
  18. Remodeling filtering blebs with the neodymium:YAG laser. Ophthalmology 1996 Oct;103(10):1700-1705.
  19. Remodelling the filtration bleb. Br J Ophthalmol 2002 Aug;86(8):872-875.
  20. Combination of autologous blood injection and bleb compression sutures to treat hypotony maculopathy. J Glaucoma 1999 Dec;8(6):384-387.
  21. Compression sutures: a new treatment for leaking or painful filtering blebs. Investigative Ophthalmology & Visual Science 1996;37(3).
  22. Excisional bleb revision to correct overfiltration or leakage. J Glaucoma 2000;9(2):169-173.
  23. Efficacy and safety of transconjunctival scleral flap resuturing for hypotony after glaucoma filtering surgery. Graefes Arch Clin Exp Ophthalmol. 2008;246(12):1751-1756.
  24. Resuturing the scleral flap leads to resolution of hypotony maculopathy. J Glaucoma. 1996;5(4):246-251.
  25. Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy. Can J Ophthalmol. 2009;44(5):567-570.
  26. Control of intraocular pressure after trabeculectomy. Surv Ophthalmol. 1999 Jan-Feb;43(4):345-355.
  27. Hypotonous maculopathy after trabeculectomy with subconjunctival 5-fluorouracil. Am J Ophthalmol. 1992 Nov 15;114(5):544-553.
  28. Flap suture--a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol 2008 Jun;246(6):869-874.
  29. Long-term results after transconjunctival resuturing of the scleral flap in hypotony following trabeculectomy. Am J Ophthalmol 2013 May;155(5):864-869.
  30. Outcomes of conjunctival compression sutures for hypotony after glaucoma filtering surgery. Eur J Ophthalmol 2013 Jul-Aug;23(4):593-596.
  31. Hypotony maculopathy following trabeculectomy with mitomycin C. Arch Ophthalmol 1992 Aug;110(8):1049-1050.
  32. Hypotony maculopathy: clinical presentation and therapeutic methods. Ophthalmol Ther 2015 Dec;4(2):79-88.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.