The Effect of Steroids in the Treatment of Ocular Hypotony Associated with Proliferative Vitreoretinopathy.

Abstract

To investigate the effect of local corticosteroids in treating ocular hypotony in eyes with proliferative vitreoretinopathy (PVR). Eyes with PVR and at least two consecutive episodes of IOP ≤ 6 mmHg, spaced at least one month apart, treated with local steroids from January 2015 to December 2022, were studied retrospectively. Patients with <6 months of follow-up were excluded. Treatment failure was defined as: IOP ≤ 6 mmHg 6 months post-steroid initiation, need for silicone oil tamponade to raise IOP, recurrence of hypotony, enucleation/evisceration, or phthisis/pre-phthisis. 208 eyes were included. All eyes received topical steroids with 17 (8.2%) receiving sub-tenon steroid injection, and 5 (2.4%) receiving intravitreal steroid injection after a median of 112 days and 70 days following the first episode of hypotony. The mean IOP at baseline was 3.4 mmHg and increased to 4.7 mmHg at 3 months, 5.9 mmHg at 6 months, 6.2 mmHg at 12 months, and 6.5 mmHg at the final visit (all P<0.001). In total, 75% met treatment failure criteria. Eyes that failed treatment exhibited significantly lower baseline IOP, a longer duration of hypotony, a higher incidence of grade C PVR, and required more extensive retinectomy (all P<0.001). In eyes with hypotony secondary to PVR, the mean IOP increased from 3.4 mmHg at baseline to 6.5 mmHg at the final visit with steroid treatment . Eyes that failed treatment were more likely to exhibit high-grade PVR, undergo more extensive retinectomies, have lower baseline IOP, and experience a longer duration of hypotony.