The following transcript has been edited for clarity:

Dr. Qiu: Welcome to AAO 2025 in Orlando, Florida. I'm Mary Qiu, MD, from Cleveland Clinic, and this is Aakriti Garg Shukla, MD, MSc, from Columbia.

Dr. Shukla: You're joining us for a session of Glaucoma Group Therapy. We’ll be sharing our surgical triumphs and unfortunate failures. Several of our panelists who just presented will be sharing these with you. Enjoy!

Case Title: Management of Hypotony Maculopathy Following Trabeculectomy with Mitomycin C, by Astrid Werner, MD

Dr. Werner: I'm Astrid Werner, MD; I'm a glaucoma specialist from Tufts Medical Center in Boston.

Dr. Qiu: Do you want to tell us a little bit more about the case you just presented?

Dr. Werner: I presented a case of a patient with visually significant hypotony maculopathy after trabeculectomy. This patient was sent in for a second opinion about what to do about the hypotony maculopathy; it had been going on for about 7 years and it was very visually significant. Her vision was 20/400 in this eye. We discussed the various options for handling hypotony due to overfiltration of a bleb. We discussed some nonsurgical options that you can try in clinic to see if they help, and then we also discussed the various techniques for revising an overfiltering bleb, along with the pros and cons of the various techniques. We ultimately ended up doing a bleb revision where we removed the old ischemic bleb tissue to visualize the scleral flap and did a customized approach where we dealt with the overfiltration but also allowed a little bit of flow to help control the patient’s glaucoma while treating the hypotony maculopathy.

Dr. Qiu: Thank you so much, Dr. Werner, for sharing this great case. You can't be glaucoma surgeons without dealing with hypotony maculopathy, so hopefully everyone will now know what to do when faced with this situation. GP