Hypotony Maculopathy after 23-Gauge Transconjunctival Sutureless Vitrectomy: A Case Report

Purpose: To describe a case of hypotony maculopathy following 23-gauge transconjunctival sutureless vitrectomy. Methods: A case report and literature review. Results: A 39-year-old man had penetrating injury of his left eye by a piece of iron. Scleral perforation, intraocular foreign body, traumatic cataract, retinal break and retinal vessel occlusion were noted during initial examination. He received emergent surgery of the scleral wound, 20-gauge pars plana vitrectomy, lensectomy and removal of the intraocular foreign body, followed by 23-gauge sutureless vitrectomy and secondary intraocular lens implantation 10 weeks later. His preoperative best corrected visual acuity was 0.3 and the intraocular pressure (IOP) was 8 mmHg. However, IOP decreased to 4 mmHg on the postoperative day 6. Fundus examination showed retinal vascular tortuosity and choroidal folds. He was treated with prednisolone acetate 1% four times a day. The IOP spontaneously returned to 15 mmHg 3 weeks after the operation. His best corrected visual acuity gradually improved to 1.0 at the 11th week. Conclusions: Postoperative hypotony following sutureless vitrectomy is not uncommon, and usually resolves spontaneously without other complications. Young age and a previous vitrectomy are risk factors related to postoperative hypotony. However, postoperative hypotony maculopathy is an uncommon complication. Our patient had persistent hypotony following a 23-guage sutureless vitrectomy complicated by hypotony maculopathy. It resolved spontaneously after conservative treatment.