Glaucoma possible after retina procedures
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Key takeaways:
- There is a high prevalence of glaucoma patients undergoing retina procedures and a high incidence of glaucoma following retina surgery.
- Treatment depends on the mechanism of action.
Patients who have undergone retina procedures have a relatively high rate of glaucoma, according to a speaker at the American Glaucoma Society meeting.
“There’s a high prevalence of glaucoma patients undergoing retina procedures, anywhere from 10% to 20%,” Pratap Challa, MD, said. “There’s also a high incidence of glaucoma following retina surgery, about 6% to 10%.”
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Challa said the treatment for glaucoma in patients undergoing retina procedures depends on the underlying mechanism. For patients with secondary angle closure following scleral buckle surgery, Challa said vascular congestion usually resolves within a few weeks.
“You can usually manage these patients with aqueous suppressants, mydriatics and even oral carbonic anhydrase inhibitors,” Challa said.
In patients with pupillary block, Challa suggested using inferior peripheral iridotomy. However, he noted that the rate of peripheral iridotomy closure can be as high as 30%.
“If there’s an overfill, you can remove a small volume to lower the pressure,” he said. “If you have to put a tube in, with silicone oil in particular, inferior tube is preferred. Just be careful about myotics due to the risk of retinal detachment and possibly prostaglandin analogs due to inflammation.”
Most patients can be controlled with medical management, but if that fails, Challa said the usual glaucoma surgeries can be considered. If the ocular nerve is healthy and IOP is moderately elevated, Challa said selective laser trabeculoplasty and MIGS are good options. If the nerve is more advanced or IOP is very high, the situation might call for trabeculectomy, tube shunt or cyclophotocoagulation.
“Like most glaucomas, we need to think about the underlying mechanism and treat accordingly,” Challa said. “Of course, this group can present some unique surgical challenges.”
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Challa P. Buckle up for high IOP post retinal surgery and intravitreal injections. Presented at: American Glaucoma Society meeting; March 2-5, 2022; Austin, Texas.
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