UK researchers have shown a low-cost gel injection can restore eye pressure and improve vision in patients with chronic hypotony, a rare and previously difficult-to-treat cause of progressive sight loss.
The work, led by Moorfields Eye Hospital and published in the British Journal of Ophthalmology, evaluated repeated intraocular injections of hydroxypropyl methylcellulose (HPMC), a viscoelastic gel used in eye surgery, particularly cataract surgery, to maintain the eye's shape.
Hypotony, defined as intraocular pressure (IOP) below 6.5mmHg, can distort ocular anatomy and lead to irreversible vision loss over several years. Until now, treatment options for progressive cases have largely been limited to silicone oil, which can impair vision and cause long-term toxicity.
Eight eyes received intravitreal HPMC injections (70µL–1,400µL), administered every 2–4 weeks to gradually increase IOP until either pre-morbid axial length was achieved, an IOP of 10–15mmHg was sustained for four weeks without signs of hypotony, or axial length of the contralateral eye was reached. They were followed up for 12 months after the first injection. Seven showed improvements in best-corrected visual acuity, IOP and axial length. Median IOP rose from 3.5mmHg at baseline to 9mmHg at 12 months, while axial length increased in six eyes by a median of 1mm. Visual acuity improved in seven eyes, with one remaining stable. Patients will continue to be monitored and may require ‘top up’ treatments, said Moorfields.
Moorfields ophthalmologist Dr Harry Petrushkin said the findings suggest a new way of restoring both ocular structure and function by addressing fluid balance within the eye. Researchers said the results are already informing national thinking on hypotony management and provide a foundation for larger, formal clinical trials.
