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Surgery may not be ideal in glaucomatous eyes with retinal disc hemorrhage, low IOP
SAN DIEGO — Surgery on glaucomatous eyes with low IOP and retinal disc hemorrhage may be counterproductive, with potential risks outweighing the benefits, a speaker said here.
"Disc hemorrhage is a risk factor for progression," Anthony Realini, MD, said at the American Glaucoma Society meeting. "It is not established that lowering IOP in these eyes mitigates that risk. There are significant perils to operating on an eye with a pressure of 12 mm Hg preoperatively. To my way of thinking, the risk-benefit analysis supports operating on only one eye and then stopping."
Dr. Realini cited the Collaborative Normal Tension Glaucoma Study, which showed eyes with disc hemorrhage faring no better with treatment than without treatment. In addition, 65% of eyes randomized to observation did not show further progression of glaucoma.
Operating involves risk factors such as blebitis, endophthalmitis, hypotony, wound healing and eye running, he said.
Dr. Realini said he does a "one-eye trial" to determine whether to operate on the second eye.
"If the fellow eye is progressing such that blindness is certain without further intervention in the patient's lifetime, I will, under great duress, be coerced into operating on a second eye if the first eye went flawlessly," he said.