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Recurrent macular neurosensory detachment in hypotony maculopathy managed with topical corticosteroids
  1. Renato Correia Barbosa,
  2. Ricardo Bastos and
  3. Paula Tenedório
  1. Department of Ophthalmology, Hospital Pedro Hispano, Matosinhos, Porto, Portugal
  1. Correspondence to Dr Renato Correia Barbosa; renato-barbosa{at}sapo.pt

Abstract

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.

  • Glaucoma
  • Macula
  • Retina
  • Anterior chamber

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Footnotes

  • Contributors All persons listed as authors meet authorship criteria, and all authors certify that they have participated sufficiently in the work to take responsibility for its content. Each author certifies that this material or similar material has not been submitted or published in any other publication before its submission to BMJ Case Reports. Conceptualisation: RCB and RB; acquisition of data: RCB and RB; analysis and interpretation of data: RCB, RB and PT; manuscript writing and preparation: RCB, RB and PT.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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