A recent study by researchers at University College London (UCL) and Moorfields Eye Hospital has shown that a commonly used eye injection can help treat hypotony, a rare condition previously considered untreatable. Hypotony occurs when the pressure inside the eye drops to abnormally low levels, changing the shape and internal structure of the eye. Over time, this can cause permanent vision loss.
Traditionally, treatment for hypotony involved filling the affected eye with silicone oil. While effective in some ways, silicone oil is difficult to see through and may be toxic to eye structures if left in place for long periods.
The new findings, published in the British Journal of Ophthalmology, reveal that injections containing hydroxypropyl methylcellulose (HPMC), a gel widely used in eye surgery, can safely increase both the size and pressure of eyes affected by hypotony. Seven out of eight patients who received this treatment experienced improvements in vision and restoration of normal eye length after a year-long course.
Moorfields consultant ophthalmologist Harry Petrushkin, lead author of the study, said: "We are excited that this simple treatment has proved so effective for patients with this rare condition. 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."
One patient named Nicki described her experience with sight loss following complications from uveitis. After several treatments failed to provide lasting relief or led to further problems, she participated in the trial at Moorfields Eye Hospital. "After I lost vision in my left eye, I thought, 'there has to be something else we can try'. It felt good that I'd been able to advocate for myself, like they understood my concerns," she said.
Nicki reported significant improvement after receiving HPMC injections: "We went ahead and, as the pressure improved, my vision started to come back. It was incredible! I want to keep my eyesight as long as I can, and this gives me that hope, as my sight has slowly returned. The progress I've made feels extraordinary, especially knowing that patients before me have faced irreversible sight loss.
"I remember seeing Mr Petrushkin and him saying, 'Before this treatment, people were going blind.' It's incredible to know that people are regaining vision. I highly recommend this treatment. Giving people their sight back is something special."
The clinic at Moorfields combines clinical assessment with collaboration from UCL bioengineers to better understand chronic low intraocular pressure. The project also involved students from UCL Engineering and UCL Medical School working on computational models related to the procedure.
Preliminary results from this research are already influencing discussions on standardising hypotony treatment across the UK and will inform future larger-scale clinical trials.
