Glaucoma Surgery round-up Oct 19, 2009 cases w/ 1wk post-op findings. Dealing w/ IOP spikes.

Monday October 19, 2009

Case 1:

robschertzer #Glaucoma #Surgery 78 yo WM COAG progressing w/ IOP 25 OS, prior cataract Sx; performed Trab MMC. Some subconj bleeding, otherwise A OK.

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Under pressure

On the first post-operative day, his eye pressure spiked up to 39 mmHg but was easily reduced to 0 with gentle massage. At the one week visit, his pressure was 30 and he had been sick for 2 days, including vomiting once, but denied any eye pain. Gentle massage brought the pressure down once again, this time to 4 mmHg, and the flattened bleb raised up nicely to either side. He will return for his 3 week post-op visit. He has also been warned that if he feels sick, even without eye pain, it can be due to a raised intraocular pressure and he should call us right away.

Case 2:

robschertzer #Glaucoma #Surgery 69 yo WM, COAG OU, prior Trab MMC OD >6wks ago still requires ocular massage; OS today keeping a bit looser.

On first post-operative day, IOP was 11 in the left eye with a low diffuse bleb and deep and quiet anterior chamber. The IOP in the right eye was 20 with an avascular low diffuse bleb and he was still taking his PredForte QID even though it was now more than 2 months since his surgery. Once again pointing to some of the challenges in having patients followed remotely after surgery. There is no one week follow-up information available as the patient has returned home for their ongoing care.

Case 3:

robschertzer #Glaucoma #Surgery 87 yo WM only eye as other blinded by COAG, aphakic w/ scarred limbal conj; Ahmed GV challenging but done. Phew.

On his first post-operative day, he was comfortable but his pressure was 40 mmHg. Prior to surgery, his pressure was 28 on pilocarpine 2%, Cosopt, and Lumigan 0.03%. I asked him to restart the Cosopt as there is compelling evidence that tension in the bleb releases factors that increase scarring longterm, even though the eyedrops themselves have been associated with increased scarring. Hopefully in the future, we can reduce his need for these drops as the pressure and healing stabilize over the coming months.

At the one week visit, his pressure was down to 24 mmHg, taking the Cosopt. Considering that prior to the surgery he needed this and two other meds and failed to get an IOP under 28, the surgery is beginning to help. 

robschertzer #Glaucoma #Surgery Next up 94 yo WF glaucoma progressing despite everything tried x 10 yrs for cycloablation remaining eye.

This patient has had the misfortune of being down to only light perception in her remaining eye, with IOP of 34 mmHg taking Xalatan, diamox, Cosopt and Alphagan. She had a prior Trabeculectomy 6 years prior and pars plana vitrectomy and AC washout 3 months prior for suspected endophthalmitis. Her IOP was reasonably well controlled prior to the vitrectomy.