POSTOPERATIVE INTRAOCULAR PRESSURE FLUCTUATION IN EYES WITH PRIMARY OPEN-ANGLE GLAUCOMA, HIGH MYOPIA AND CATARACT

Patients with pre-existing forms of glaucoma are at a greater risk for postoperative IOP spikes. Raised IOP following IOL-PC implantation can be seen in the early or late post operative period and can be due to variable mechanisms.

Faculty of Medicine, University “Lucian Blaga” din Sibiu, Romania

ARCADA Clinic Sibiu

We report the postoperative cataract surgery management of a 54-year-old woman diagnosed with high myopia, cataract and open-angle glaucoma.

The preoperative ophthalmological exam revealed: RE BCVA - 0.3, LE BCVA – 0.1, with an intraocular pressure (IOP) of 30 mmHg in the right eye (RE) and 28 mmHg in the left eye (LE). Central corneal thickness (CCT)  was RE 665µm, LE-667µm. Slit-lamp exam of anterior pole revealed a cotico-nuclear cataract in both eyes (OU). Posterior exam (OU) showed significant glaucomatous cupping of the optic nerve as well as myopic fundus changes. Uncomplicated cataract surgery and intraocular lens implantation for the LE was performed with topical anesthesia. In the 1-day postoperative BCVA in the LE was 0.6 with an intraocular pressure of 20 mmHg. The patient was prescribed a regimen of postoperative topical anti-inflammatory and antibiotic eye drops with follow-up recommended for 1 week. Four days after surgery, the patient presents to our clinic with decreased visual acuity and ocular pain in the left eye. BCVA on LE was 0.02 with IOP- 70 mmHg. The slit-lamp examination showed perikeratic congestion, corneal edema, deep anterior chamber and slowly reflexive pupil. Eye hypotensive treatment topical drops (Dorzolamide, Timolol) and systemic medication (Mannitol, Acetazolamide) was started immediately. After 72 h after the patient’s general condition did slightly improved, with a  decrease of IOP. One month after the initial procedure, cataract surgery was performed on the RE. Despite uncomplicated surgery, symptomatology was similar with the LE, with an intraocular pressure of 72 mmHg. Eye hypotensive treatment was started immediately with a normalization of intraocular pressure and decrease of symptoms. At three months postoperatively, BCVA OU-0.9 with an intraocular pressure of 22 mmHg in RE and 23 mmHg in the LE.

Cataract surgery in high myopia patients is challenging. Various complications may occur during and after surgery. Understanding the mechanisms of postoperative raised IOP is important to plan appropriate treatment and prevent longterm sight threatening complications of glaucoma.