Hypotony

Hypotony following surgery in uveitic eyes is felt to relate to shutdown of the aqueous humour production from acute, severe inflammation. Following PPV there are additional concerns about the possibility of wound leakage or retinal detachment, both of which should be excluded.

Hypotony usually responds to oral corticos-teroids, very frequent applications of topical corticosteroids and corticosteroid injections i.v. or even i.o. Prolonged hypotony can occur in certain eyes with a poor preoperative prognosis. High-resolution scanning of the ciliary body region may be useful to detect membranes bridging the ciliary processes that might be amenable to removal. In practical terms, only non-contact ultrasound probes can be used, as contact with a hypotonous globe collapses it and distorts the anatomy.

Assessment of atrophic ciliary processes and the presence of any cyclitic membranes at the time of the initial PPV, using indirect ophthal-moscopy and deep scleral depression, is very useful in assessing postoperative hypotony. Due to the limited visualization of cyclitic membranes under clinical circumstances, UBM may be the preferred technique. However, the morphological abnormalities underlying hypotony may not be clearly distinguished in all patients.

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