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Physicians need to be prepared for IOP spikes after glaucoma surgery
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SAN FRANCISCO — Glaucoma procedures, even minimally invasive ones such as trabecular meshwork ablation, require preparation for potential complications including IOP spikes, a presenter said here.
"The best offense is a good defense, and avoiding such complications is truly better than managing them," Carla J. Siegfried, MD, said at the American Glaucoma Society annual meeting.
Pressure spikes may occur due to factors such as viscoelastic retention and inflammation, although the reason is not always known, Siegfried said.
Carla J. Siegfried
It is essential to have careful irrigation and aspiration, whether the patient is phakic or pseudophakic, for viscoelastic retention, and the use of overnight aqueous suppressants is suitable. However, many physicians perform surgery without viscoelastic retention to prevent the possibility of a subsequent IOP spike, she said.
Siegfried said that topical steroids may be introduced during the early postoperative course, but they generally do not achieve a significant response.
"I personally use more potent steroids in the first week, especially in a combined cataract extraction, but then switch to the less potent loteprednol or rimexolone later on," she said.
Siegfried also said that gonioscopy should be monitored even though 38% of patients develop focal peripheral anterior synechiae with no effect on pressure.
Disclosure: Siegfried has no relevant financial disclosures.