ESCRS - PO395 - Trans-Incisional Aqueous Release (‘Wound Burping’) For Acute Post-Operative Intraocular Pressure Spikes Following Cataract Surgery In Angle-Closure And Open-Angle Glaucoma

Trans-Incisional Aqueous Release (‘Wound Burping’) For Acute Post-Operative Intraocular Pressure Spikes Following Cataract Surgery In Angle-Closure And Open-Angle Glaucoma

Published 2022 - 40th Congress of the ESCRS

Reference: PO395 | Type: Free paper | DOI: 10.82333/y0s0-at08

Authors: Kevin Gillmann* 1 , Sam Aryee 2 , Corrado Gizzi 3 , Shafi Balal 4 , Anant Sharma 5

1Moorfields Eye Hospital NHS Trust,London,United Kingdom;Swiss Glaucoma Research Foundation,Lausanne,Switzerland, 2Bedfordshire Hospitals NHS Trust,Bedford,United Kingdom, 3Moorfields Eye Hospital NHS Trust,London,United Kingdom;Department of Ophthalmology,Morgagni Pierantoni Hospital,Forlì,Italy, 4Moorfields Eye Hospital NHS Trust,London,United Kingdom, 5Moorfields Eye Hospital NHS Trust,Bedford,United Kingdom

Purpose

Intraocular pressure (IOP) spikes are common after cataract surgery. Although evidence on the long-term effect of this postoperative complication is scarce, acute IOP elevation has the potential to adversely affect vision, particularly in glaucoma. The aim of this study is to evaluate the safety and efficacy of trans-incisional aqueous humour release (AHR, also known as wound burping) in treating IOP spikes following uneventful phacoemulsification. While there are many anecdotal reports of surgeons performing this procedure, there is, at present, no standard technique for it, and its safety and effectiveness remain understudied.

Setting

This prospective, interventional study conducted at Moorfields Eye Department, at Bedford Hospital, Bedford, United-Kingdom.

Methods

Patients with angle-closure or open-angle glaucoma who underwent routine uncomplicated cataract surgery at the investigation site and whose 2-3-hour post-operative IOP was significantly elevated were enrolled. In all participating patients, AHR was performed at the slit-lamp, through the superior paracentesis with a sterile insulin syringe. IOP was measured immediately after the procedure and again 2-3 hours later. The procedure could be repeated as many times as required until IOP was deemed satisfactory. Side effects and IOP were recorded at the time of the procedure, the following day and after 5 weeks. The mean deviation (MD) of the last pre-operative visual field (VF) was compared with that of the first post-operative VF in both eyes.

Results

In all, 14 patients (42.9% females, 74.1 ± 12.1 years) were enrolled. Mean IOP raised from 18.4 ± 4.4 mmHg pre-operatively to 34.9 ± 8.3 mmHg 2 hours after surgery. Following AHR, mean IOP dropped to 10.5 ± 6.1 mmHg, and increased to 32.1 ± 5.8 mmHg 2-3 hours later. Ten patients (71.4%) underwent AHR a second time. Mean IOP decreased to 8.1 ± 4.9 mmHg and increased again to 27.2 ± 9.6 mmHg after 2-3 hours. Four patients (28.6%) underwent a third AHR, reducing IOP to 9.3 ± 2.2 mmHg. Mean IOP was 15.2 ± 4.9 mmHg at day 1 and 17.2 ± 5.7 mmHg at week 5. No complications were observed in any of the patients. Mean VF MD progressed by -0.87 ± 0.63 dBs peri-operatively in operated eyes compared to -0.64 ± 2.68 dBs in contralateral eyes (p = 0.809).

Conclusions

Trans-incisional aqueous humour release was safe and effective in managing IOP spikes following cataract surgery in glaucoma eyes. However, its efficacy of a single AHR was often temporary, and a significant proportion of patients required repeat procedures over the first 24 hours post-operatively. Close monitoring and aggressive post-operative IOP management may contribute to preventing peri-operative glaucoma progression.