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Glaucoma specialists should not fear temporary IOP rises after surgery, expert says
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 Elie Dahan |
PARIS — Surgeons should trust the positive effects of glaucoma surgery and not let fears and misconceptions lead them to make poor choices, according to a speaker here.
“First of all, we should not fear offering surgery to end-stage glaucoma patients. Wipeout is realistically not a risk, and the risk of other potential complications is definitely outweighed by the benefits of surgery,” Elie Dahan, MD, said at the World Glaucoma Congress.
In Dr. Dahan’s opinion, nonpenetrating surgery or the Ex-PRESS glaucoma filtration device (Alcon) should be the first option in these cases.
A transient hypertensive phase can occur after surgery with any technique but regresses spontaneously, he said. Specialists should resist administering topical IOP-lowering medications, which have a toxic effect on the healing conjunctiva and may prevent healthy bleb formation.
“[Anterior chamber] decompression is a more elegant alternative, easily performed through pre-existing paracenteses,” Dr. Dahan said.
He also recommended against massage or teaching patients to massage.
“Massage is an inaccurate, uncontrolled and potentially dangerous act,” he said.
Surgeons should avoid additional procedures in these cases and simply wait, resisting the temptation to consider IOP rise a sign of failure and go back to medical therapy.
“This would be like shooting yourself in the foot. Instead, sit on your hands and wait. Replace steroids with non-preserved NSAIDs. Allow the IOP to rise to the low 20s and it will settle back to normal levels within 2 to 3 weeks,” Dr. Dahan said.
- Disclosure: Dr. Dahan consults for Alcon Laboratories.