MACULAR OUTER RETINAL ATROPHY AFTER VITRECTOMY AND HYPOTONY: TWO CASES

Purpose: To characterize two cases of focal outer retinal atrophy and hypotony after vitrectomy. Methods: Retrospective chart review of two patients' records between 2019 and 2023. Results: Patient 1 underwent vitrectomy, epiretinal membrane peel, and cataract extraction for visually significant macular pucker. She developed hypotony without a wound leak and was noted to have a focal parafoveal area of ellipsoid zone disruption by 1 week postoperatively, which evolved into outer retinal and chorioretinal atrophy within 6 weeks after surgery. This area of atrophy remained stable in size, but the patient later reported a paracentral scotoma. Patient 2 had multiple previous surgeries for retinal detachment with proliferative vitreoretinopathy. Seven years later, the intraocular lens dislocated and was exchanged with scleral fixation of a new intraocular lens. On postoperative Day 1, he had hypotony with macular folds secondary to a leaking sclerotomy wound. The sclerotomies were sutured on postoperative Day 3, and his intraocular pressure normalized. However, he developed a central, focal area of chorioretinal atrophy within 1 week of the initial surgery. The size of this area of atrophy remained stable for years but resulted in reduced central vision. Conclusion: Hypotony after vitrectomy may rarely predispose patients to the development of focal chorioretinal atrophy.