Low incidence of hypotony maculopathy following primary mitomycin C trabeculectomy in Southern India

Purpose: Mitomycin C (MMC) is used to increase the success rate of filtration surgery, but is associated with a higher rate of complications, the most worrisome of which is hypotony maculopathy. We evaluated the complication rate of primary MMC trabeculectomy in a Southern Indian population. Methods: 775 eyes of 702 consecutive patients undergoing primary trabeculectomy were retrospectively reviewed. Patients with uveitic, traumatic, or neovascular glaucoma or with any prior intraocular surgery were excluded. All had a fornix-based flap and a single releasable suture, with topical intraoperative application of MMC. Results: Age ranged from 1 to 85 years, mean 51 years. Hypotony maculopathy occurred in 8 eyes. Of the patients with hypotony maculopath), 4 were male and 4 were female. Refractive error was plano in 3 eyes, and between -1.00 and -4.00 diopters in 5 eyes. Age range was 16-33 years (mean 25 years) in this subgroup. MMC 0.4 mg/ml for 2 minutes was used in 4 eyes and MMC 0.2 mg/ml for 4 minutes was used in 4 eyes. Final visual acuity worsened in 5 eyes, improved in 2 eyes, and was unchanged in 1 eye, with follow-up between 1 and 39 months (mean 14.5 months). Cataract progression occurred in 3 of these eyes. Hypotony maculopathy was significantly correlated with youth (p<.05). Conclusions: The overall incidence of hypotony maculopathy (1%) is low in this group of pigmented patients. Youth appears to be the main risk factor for hypotony maculopathy in this large series.