World-first Hypotony Treatment Shows Remarkable Vision Restoration Results
Moorfields Eye Hospital researchers have demonstrated that a commonly used surgical gel can effectively treat chronic hypotony, a previously untreatable condition that leads to progressive vision loss.
A study published in the British Journal of Ophthalmology has revealed that injections of hydroxypropyl methylcellulose (HPMC) , a low-cost gel routinely used in eye surgery, can restore both eye anatomy and vision in patients suffering from chronic hypotony.
The research, conducted at the world's first dedicated hypotony clinic at Moorfields Eye Hospital, represents a significant breakthrough for managing a rare but devastating condition characterised by abnormally low intraocular pressure.
Understanding hypotony's impact
Hypotony occurs when the eye's pressure drops below normal levels, altering the eye's shape and internal structure. This can result from underlying conditions that damage the eye's fluid-producing mechanisms, responsible for maintaining normal pressure.
Over time, the condition leads to progressive and often permanent vision loss, with some patients facing blindness after several years. Until now, treatment options have been severely limited.
Breaking new ground
The study demonstrated remarkable outcomes across seven of eight patients who completed a 12-month treatment course. All patients showed improvements in vision, eye pressure normalisation, and restoration of eye length.
"We are excited that this simple treatment has proved so effective for patients with this rare condition," said Moorfields consultant ophthalmologist Harry Petrushkin. "This is the start of a process of understanding more about the balance of fluid inside the eye, leading to improved care for our patients."
The treatment involves ocular injections of HPMC gel to increase the volume of affected eyes that have lost sight but still retain light perception. This approach offers significant advantages over the previous standard treatment of silicone oil filling.
Advantages over existing approaches
While silicone oil has provided benefits for hypotonic eyes, it presents notable limitations. The material can prove toxic to ocular tissues during long-term use and compromises visual clarity due to its optical properties.
HPMC gel, by contrast, is already widely used in ophthalmic surgery, is well-tolerated, and provides clearer visualisation. Its low cost also makes it an accessible option for broader clinical application.
Patient outcomes driving hope
The clinic's success is exemplified by patient Nicki, whose sight deteriorated following cataract surgery complications related to uveitis. After exhausting conventional treatments including steroids and silicone oil, she faced vision loss in both eyes due to hypotony.
Following HPMC gel injections, Nicki experienced vision restoration. "As the pressure improved, my vision started to come back. It was incredible," she said. "The progress I've made feels extraordinary, especially knowing that patients before me have faced irreversible sight loss."
Clinical implications and future directions
The Moorfields hypotony clinic, enabled through funding from Moorfields Eye Charity, integrates structured clinical assessment with bioengineering collaboration from University College London to better understand the mechanisms driving chronic low intraocular pressure.
This preliminary data is already informing discussions on standardised hypotony treatment protocols nationally and provides a foundation for future large-scale clinical trials to formally evaluate the approach's efficacy.
This development offers new hope for eyecare professionals managing patients with this challenging condition, providing an evidence-based treatment option where previously none existed.
