A world-first project at UCL and Moorfields Eye Hospital suggests a low-cost gel already used in eye surgery could help restore sight in patients with a rare, previously untreatable cause of blindness. Early results are reshaping how doctors think about treating chronically low eye pressure.
A simple clear gel already used in routine eye surgery may offer new hope to people at risk of blindness from a rare, previously untreatable condition that causes dangerously low eye pressure.
In a world-first project, researchers at University College London and Moorfields Eye Hospital have shown that injections of hydroxypropyl methylcellulose, or HPMC, can safely raise eye pressure, restore the eye’s shape and, in many cases, bring back vision in patients with ocular hypotony.
Hypotony happens when the eye’s internal pressure drops well below normal levels. That low pressure can cause the eyeball to shrink and deform, damaging delicate internal structures over time. The process is often slow but relentless, and it can end in permanent vision loss and even blindness.
The condition can develop when diseases or previous treatments injure the part of the eye that produces the clear fluid needed to maintain normal pressure and support the eye’s shape. Because it is rare and complex, people with hypotony have historically had few good options.
Until now, the main way to try to preserve vision in severely affected eyes has been to fill them with silicone oil. The oil can help prop up the eye and stabilize pressure, but it is far from ideal. It can be toxic to eye tissues if left in place for long periods, and because it is not transparent like natural eye fluid, it can make it hard for patients to see clearly.
The new study, published in the British Journal of Ophthalmology, suggests that HPMC injections could offer a safer, clearer alternative.
HPMC is a low-cost, gel-like substance that eye surgeons already use widely during cataract and other operations to protect the cornea and maintain space inside the eye. In this project, clinicians repurposed it as a long-lasting internal support for eyes with hypotony, injecting it to increase the volume inside the eye and gently raise pressure.
The team followed eight patients treated at the world’s first dedicated hypotony clinic at Moorfields, set up with support from Moorfields Eye Charity. Over 12 months of treatment, seven of the eight patients experienced improvements in vision, eye pressure and eye length, suggesting that the gel helped restore both structure and function.
“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,” lead author Harry Petrushkin, a Moorfields consultant ophthalmologist, said in a news release.
The early results go beyond what he expected from a first-in-kind trial, according to co-author Gus Gazzard, a professor of glaucoma studies in the UCL Institute of Ophthalmology and Moorfields consultant ophthalmic surgeon & glaucoma service director.
“This is a truly transformative new therapy that brings hope to patients otherwise without options, for what was previously an untreatable blinding and disfiguring condition. This robust proof of principle study has already exceeded my hopes of what sight recovery might be achievable,” he said in the news release.
Because the project is a small pilot, the researchers stress that more work is needed before the treatment can be rolled out widely. Larger, formal clinical trials will be required to confirm safety, refine dosing and technique, and understand which patients are most likely to benefit.
Still, the initial data are already influencing how specialists think about managing hypotony across the U.K., and the clinic’s experience is helping shape emerging national guidance on standardized care.
Behind the numbers are patients like Nicki, who has lived with serious eye problems for years.
Nicki’s eye troubles began shortly after the birth of her son, when she was diagnosed with uveitis, an inflammatory condition inside the eye. For several years she had no symptoms, but later developed cataracts and other complications that threatened her sight.
Doctors tried multiple treatments, including steroids and silicone oil. Some helped for a while, but others caused sudden drops in eye pressure or even complete loss of vision. Losing sight was frightening, but it also pushed her to learn about new research and to speak up about her options.
Her turning point came when her Moorfields consultants began exploring an alternative to silicone oil and offered her the HPMC injection, a clear gel designed to support pressure and help the eye function more normally.
For Nicki, the change was dramatic.
“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,” she said.
The hypotony clinic at Moorfields is not just delivering care; it is also a hub for research and engineering collaboration. Clinicians there work closely with bioengineers in UCL’s Department of Mechanical Engineering to better understand what drives chronic low eye pressure and how mechanical forces inside the eye change as treatments are given.
Through the UCL Institute of Healthcare Engineering’s summer studentship program, engineering students have helped build a computational model of the eye that can simulate how different volumes and pressures affect its shape. Two UCL medical students also contributed to the project and are co-authors on the research paper, reflecting the initiative’s emphasis on training the next generation of clinician-scientists.
By combining real-world patient data, advanced modeling and a simple, widely available material, the team hopes to refine the HPMC injection technique and explore how it might be adapted or combined with other therapies.
Gazzard said he hopes the treatment can be made available to more patients, but emphasized that the field is still in its early days and that further funding will be needed to optimize and test the approach in larger groups.
For now, the pilot results offer something that has long been missing for people with hypotony: a realistic path to preserving, and in some cases regaining, sight.
Source: University College London