Hypotony Maculopathy: A Silent Mimicker of Common Macular Diseases With Nonspecific Optical Coherence Tomography Findings

To highlight the diagnostic challenge of eyes with hypotony maculopathy with concurrent macular diseases and to present optical coherence tomography (OCT) imaging findings in hypotony maculopathy. Retrospective review of 15 eyes of 12 patients with hypotony maculopathy at a single institution. Low intraocular pressure (IOP) was caused by overfiltration from trabeculectomy in 9 eyes (of 15, 60%), overtreatment with topical aqueous suppressants after trabeculectomy in 3 eyes (of 15, 20%), bleb leak in 1 eye (of 15, 7%), and treatment with topical aqueous suppressants alone in 2 eyes (of 15, 13%). On OCT imaging, 7 eyes (of 15, 47%) had chorioretinal folds without intraretinal fluid (IRF) or subretinal fluid (SRF), 5 eyes (of 15, 33%) had either IRF or SRF with chorioretinal folds, and 3 eyes (of 15, 20%) had IRF or SRF without chorioretinal folds. The majority of eyes (11 of 15 eyes, 73%) had additional diagnoses apart from hypotony maculopathy that could have potentially caused IRF or SRF, which included epiretinal membrane, retinal vein occlusion, and age-related macular degeneration. Two eyes (of 15, 13%) were initially erroneously managed for a nonhypotony maculopathy pathology due to the diagnostic challenge in eyes with hypotony maculopathy. Hypotony maculopathy demonstrates nonspecific OCT findings such as IRF and SRF that are commonly seen in other macular diseases. In eyes with these macular diseases, diagnosing hypotony maculopathy may be challenging; thus, attention to past ocular history and IOP must always be part of evaluation