Glaucoma Surgery: Postoperative Management, Complications, and Prognosis
Jing Jin, MD, PhD
ANGLE SURGERY (GONIOTOMY OR TRABECULOTOMY) (SEE CHAPTER 10)
Postoperative management:
Patient should be kept quiet with head elevated for 24-48 hours with the operative eye shielded at all times.
Postoperative medication regimen:
1% Pilocarpine twice a day for 2-4 weeks.
Antibiotic/steroid drop or ointment 4 times per day for 1 week.
Closely monitor IOP in follow-up period. May need examination under anesthesia to ensure adequate pressure control.
Complications:
Inadequate IOP control. The patient may require further surgery and should be monitored at regular intervals even if IOP is controlled in the immediate perioperative period.
Hyphema:
Common with angle surgery.
Usually resolves spontaneously within 1 week.
Nonclearing vitreous hemorrhage may necessitate vitrectomy in the first or second month postoperatively. Pseudophakic or aphakic eyes undergoing 360-degree angle surgery are at highest risk for this complication.
Lens damage, cataract:
Patients with aniridia who have an exposed lens are at high risk for this complication.
Iridodialysis.
Cyclodialysis cleft:
May result in prolonged postoperative hypotony.
Cleft can be confirmed with ultrasound biomicroscopy or anterior segment OCT as gonioscopy may be challenging.
Many clefts will close spontaneously within the first month. If the cleft does not close, surgical closure of the cleft is indicated.
Peripheral anterior synechiae.
Retinal detachment.
Endophthalmitis.
Prognosis:
Success rate in infants who present between 3 months and 1 year of age with primary congenital glaucoma is reported to be 70%-80%.
The success rate for 360-degree trabeculotomy is greater than traditional trabeculotomy.2
GLAUCOMA DRAINAGE DEVICE (SEE CHAPTER 11)
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