Hypotony severity affects management in patients undergoing cataract surgery
LAS VEGAS — Effective strategies to treat hypotony in patients with prior trabeculectomy who are undergoing cataract surgery vary depending on severity, according to a speaker here.
“I would argue that in cases of severe hypotony, you would be better doing it beforehand,” Erin A. Boese, MD, said at Glaucoma Subspecialty Day at the American Society of Cataract and Refractive Surgery meeting.
Surgical trabeculectomy revision can change the IOL measurements, Boese said, so hypotony should be resolved before cataract surgery in severe cases.
“What you’re looking to do is reduce the flow through that scleral flap,” Boese said. When employing this strategy, physicians should remember the patients received prior trabeculectomy for a reason and should consider what they are willing to do to increase flow in the future. For patients on the edge of hypotony, Boese said surgeons can go forward with a standard surgery and use fewer postoperative drops.
“We know that post-trabeculectomy phacos can cause smaller blebs and can increase IOP between 2 mm Hg and 4 mm Hg,” Boese said. “What I am trying to do is harness that small amount of intraoperative inflammation from the cataract surgery to see if I can get a little more subconjunctival scarring in that bleb and bump up the IOP.”
Finally, in patients with minimal hypotony, Boese said a blood patch can be effective to raise IOP.
“The reason I like it is it utilizes techniques a lot of us already know,” Boese said. “A lot of us are comfortable needling at the slit lamp, and this is not that different.”
Boese recommended using an assistant to draw the blood to make the timing of the procedure easier.
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Boese EA. No pressure: Cataract surgery in patients with an overfiltering trabeculectomy. Presented at: American Society of Cataract and Refractive Surgery meeting; July 23-27, 2021; Las Vegas.
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