In Vivo Optical Coherence Tomography Outcomes of Hypotony After Trabeculectomy Management with Autologous Blood Injection: A Single-Center Retrospective Study

Background: This study aimed to report the efficacy and safety of peribleb autologous blood injections in patients with hypotony maculopathy following trabeculectomy. Methods: In this retrospective chart-review study, patients with hypotony maculopathy from over-filtering bleb following mitomycin C (MMC)-augmented trabeculectomy treated with ≥1 peribleb autologous blood injections, ≥12 months of follow-up, and macula optical coherence tomography (OCT) imaging were included. Patients with previous laser cyclophotocoagulation were excluded. Hypotony maculopathy was defined as choroidal folds in the macular region, as assessed by OCT. Results: Nine patients met the inclusion criteria (mean age 62.3 ± 17.0). The mean intraocular pressure (IOP) at hypotony maculopathy diagnosis was 3.8 ± 1.5 mmHg. Most (n = 7) patients received a single injection (4 injections n = 1, 5 injections n = 1). Significant improvements in mean overall IOP after blood injection were observed (8.3 ± 2.4 mmHg; p = 0.008). Improvements in visual acuity and the resolution of hypotony maculopathy were observed in patients requiring a single injection only. No intra-operative adverse events were recorded. Successful bleb surgical revision was performed for two patients refractory to blood injections. Conclusions: Peribleb autologous blood injection increased IOP, improved visual acuity, and resolved hypotony maculopathy in 5.3 weeks in 7/9 patients. This procedure is not a contra-indication for further surgical revision.