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

Purpose: To investigate the effect of local corticosteroids in treating ocular hypotony in eyes with proliferative vitreoretinopathy (PVR). Methods: 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. Results: 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). Conclusion: 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.