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Glaucoma surgery associated with IOP rise in fellow eye
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Following glaucoma surgery in one eye, researchers found that intraocular pressure rose in the fellow eye, according to a study recently published in the Journal of Glaucoma.
Kaushik and colleagues conducted a prospective interventional study of 71 patients who were scheduled to undergo glaucoma surgery in one eye.
All patients had primary or secondary glaucoma, but researchers analyzed both glaucomatous and normal fellow eyes. Researchers measured IOP at baseline and 1 week following the surgery until 6 months after surgery. The researchers also noted that patients who were treated with acetazolamide were analyzed separately from the rest of the patients.
Results showed that all types of patients – those with normal fellow eyes and glaucomatous fellow eyes as well as those treated with acetazolamide – experienced a significant increase in IOP in the fellow eye.
The researchers also reported that by the end of the study, 24 patients required an increase in medication or surgery in the fellow eye in order to control IOP.
"The clinical importance of this study is to recognize these changes in IOP possible after glaucoma surgery due to multitude of factors coming in play," the authors wrote. "A relevant message is that the fellow eye needs to be carefully monitored after glaucoma surgery in one eye. In many instances, the fellow eye is often the one with useful vision. Failure to recognize and monitor IOP changes careful may unnecessarily delay treatment and appropriate management of these eyes.
"In addition, fellow eyes already damaged by glaucomatous processes may be at significant risk of glaucoma progression due to higher IOP levels in the postoperative period,” they continued. “In addition, this study reiterates that in studies of IOP responses to a particular treatment, the fellow eye should not be used as a control."
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Although glaucoma is oftentimes a bilateral condition, clinicians typically assess and treat each eye independently. This study reveals a suspected physiological connection between the eyes that causes a nonsurgical eye to undergo IOP changes as a result of invasive glaucoma surgery in the other eye – a quizzical finding with uncertain mechanisms at play.
The implication for a resultant IOP increase in the fellow nonsurgical eye is significant. Potentially, helping one eye could hurt the other. Despite this, trabeculectomy and glaucoma drainage device implant surgery will remain critical for managing recalcitrant elevated intraocular pressure in many patients.
Therefore, this unintended consequence of these surgeries should be met with a heightened clinical awareness by comanaging eye care professionals. This pattern seems to be somewhat common, and those managing glaucoma will need to recognize when this becomes problematic.
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