A Case of Idiopathic Bilateral Profound Hypotony

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To the Editor:
We read with great interest the article by Provencher et al1 concerning 1 case of idiopathic bilateral profound hypotony in an unknown progressive neurodegenerative disorder.
We would like to thank the authors because they cited 1 study we published in 2011, where we found the ciliary body detachment to be the reason of low intraocular pressure (IOP) in patients with myotonic dystrophy.2
Our studies to understand the reasons of low IOP in myotonic dystrophy patients started in 2009 and allowed us to exclude that the low IOP was due to abnormal corneal characteristics that would have influenced the IOP readings3,4 conversely to patients with facio-scapulo-humeral muscular dystrophy that have low IOP too, but showed thinner corneas, explaining the lower IOP measurement.5
It is evident that the presence of symptoms in the described patient exclude the incorrect IOP reading due to the presence of corneal abnormalities, even if we were not able to find information on the cornea status apart an astigmatism of 7 D that could have given no more of 2 mm Hg underestimation if with-the-rule or overestimation if against-the-rule.6,7
The only finding that makes us suspicious is the presence of shallow anterior chamber with low IOP that strongly advise the presence of a ciliary body detachment.
Sometime to detect such a detachment, even with high frequency ultrasound, can be challenging, for this reason we would like to suggest the authors to closely check the attachment of the ciliary body for 360 degrees, decreasing the sensitivity of the machine, to better point out the presence of even a very shallow detachment that in our opinion is the most logical option for this patient.
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