{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:28:54Z","timestamp":1787531334450,"version":"build-2736575974"},"reference-count":22,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T00:00:00Z","timestamp":1768089600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017645","name":"Moorfields Eye Charity","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017645","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,11,17]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>To report visual and anatomical outcomes following intravitreal hydroxypropylmethylcellulose (HPMC) for the treatment of chronic structural hypotony.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a prospective interventional case series. Eight patients with chronic structural hypotony for more than 3\u2009months, defined by an intraocular pressure (IOP) of &lt;6.5\u2009mm Hg. All patients had evidence of visual potential, clear cornea and a clear visual axis.<\/jats:p>\n                    <jats:p>Patients received multiple intravitreal HPMC injections (70 \u00b5L\u20131400\u2009\u00b5L), administered every 2\u20134 weeks until either pre-morbid axial length was achieved, an IOP of 10\u201315\u2009mm Hg was sustained for 4\u2009weeks without signs of hypotony, or axial length of the contralateral eye was reached. They were followed up for 12 months after the first intravitreal injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (LogMAR) improved in 87.5% of eyes, with one eye remaining stable. The initial BCVA range was 0.3\u20131.7 LogMAR, and the final range was 0.1\u20131.6 LogMAR. IOP increased in 87.5% of eyes, from an initial range of 1\u20135 mm Hg to 3\u201323 mm Hg. Axial length increased in 75% of eyes, with a median increase of 1 mm (range 0.6\u20132.9 mm).<\/jats:p>\n                    <jats:p>Two adverse events occurred: uveitis flare-ups leading to loss of HPMC clarity in two eyes, managed with topical and intravitreal steroids, and two cases of temporary vision loss post-injection, resolved after paracentesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first case series to use a structured protocol for intravitreal HPMC in chronic hypotony management. The treatment improved vision and restored ocular anatomy, showing promise for managing structural hypotony in eyes with visual potential.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-327866","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T01:20:20Z","timestamp":1768180820000},"page":"857-862","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Novel therapeutic strategies to restore vision in ocular hypotony (STRETCH): results from a prospective pilot series"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4400-6090","authenticated-orcid":false,"given":"Karla","family":"Orsine Murta Dias","sequence":"first","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Yang","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Calcagni","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital City Road Campus, London, UK"},{"name":"Institute of Ophthalmology, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal Riymon","family":"Kawa","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Gooch","sequence":"additional","affiliation":[{"name":"Ultrasound, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diya","family":"Shah","sequence":"additional","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2295-6612","authenticated-orcid":false,"given":"Rana","family":"Khalil","sequence":"additional","affiliation":[{"name":"Tennent Institute of Ophthalmology, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Sutaria","sequence":"additional","affiliation":[{"name":"University College London Medical School, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hari","family":"Jayaram","sequence":"additional","affiliation":[{"name":"Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1982-5005","authenticated-orcid":false,"given":"Gus","family":"Gazzard","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"},{"name":"University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7430-2680","authenticated-orcid":false,"given":"Louisa","family":"Wickham","sequence":"additional","affiliation":[{"name":"Moorfields Eye Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Petrushkin","sequence":"additional","affiliation":[{"name":"Uveitis and Scleritis Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK"},{"name":"Rheumatology, Great Ormond Street Hospital for Children, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,11]]},"reference":[{"key":"2026072202101931000_110.8.857.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2015-307799"},{"key":"2026072202101931000_110.8.857.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2019.04.006"},{"key":"2026072202101931000_110.8.857.3","unstructured":"Okonkwo ON , Tripathy K . 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