PURPOSE: To describe the clinical findings of hypotony maculopathy using 3-dimensional (3D) topography maps reconstructed from spectral domain optical coherence tomography (SD-OCT) imaging, and compare SD-OCT with time domain OCT (TD-OCT) for hypotony maculopathy diagnosis. METHODS: This was an observational noncomparative case series comprising 7 patients with hypotony maculopathy after trabeculectomy with mitomycin-C. All patients underwent consecutive imaging with TD-OCT (Stratus OCT) and SD-OCT using various high-resolution instruments. 3-D surface maps obtained using SD-OCT were compared with linear scans obtained using TD-OCT. RESULTS: Two of 7 eyes had minimally detectable folds with TD-OCT imaging in the vertical axis. Five eyes did not show folds on TD-OCT. 3-D topographic maps using SD-OCT demonstrated advanced retinal and subretinal folds throughout the macular region in all 7 patients. All eyes (4 cases) with no topographically detectable folds using SD-OCT within the foveal avascular zone had visual acuity of 20/25 or better. Three eyes with obvious contour disruption within the foveal pit had visual acuity ranging from 20/30 to 20/70. CONCLUSIONS: SD-OCT using 3-D surface topography mapping provides greater sensitivity for hypotony maculopathy diagnosis and monitoring as compared with TD-OCT. Disruption of the foveal pit as detected using SD-OCT is associated with reduced visual acuity.