High eye pressure after retina surgery12/18/2023 However, that increasing number of injections has drawn attention to their potential drawbacks-including the potential IOP-related consequences of injecting a volume of material into the eye.įrom the beginning, everyone understood that pushing fluid into the eye can cause the pressure to increase in the short term. The IRIS Registry shows that 524,485 patients received 2,419,931 injections in 2016 alone. Today, intravitreal injections of anti-VEGF drugs are increasingly common. This led to the clinical trials studying ranibizumab, the off-label use of bevacizumab and ultimately the development of aflibercept. Retina specialists rapidly made the association that certain intraocular conditions like age-related macular degeneration were also VEGF-mediated processes. The premise was that tumors required a prominent blood supply to continue growing, and it was determined that this angiogenesis was a VEGF-mediated process. The idea of anti-VEGF medications comes from the oncology world. (I won’t discuss intravitreal or periocular steroid injections, because those are well known to cause an increase in IOP, and they’ve been extensively documented and discussed elsewhere.) In particular, I’ll discuss anti-VEGF injections, vitrectomy surgery with or without tamponade, the use of a scleral buckle and the use of panretinal photocoagulation laser. Here, I’d like to share some of what we know about this concern, the patients who may be at risk, and what we can do to prevent negative consequences from arising-and treat them if they do. For that reason, spreading awareness of this issue can be helpful. However, sometimes a patient is sent to a glaucoma specialist only after the pressure has been elevated for a while. Thus, to avoid glaucoma-related complications, it behooves us to identify patients who may be more susceptible to damage in this situation.Īs a retina specialist, I know that my glaucoma colleagues are aware of this issue, and there’s usually good communication between the retina and glaucoma teams. However, susceptibility to damage in some patients can cause even a brief rise in pressure to be consequential and in other patients, the brief pressure spike can be followed by a long-term IOP increase. In most cases, the increase is temporary, so although the pressure can become quite high, consequences are usually minimal or nonexistent. Unfortunately, many retina-related procedures, including anti-VEGF injections and some surgical interventions, can cause an increase in IOP. Patients with medically uncontrolled glaucoma after silicone oil injection may require oil removal with or without concurrent glaucoma surgery.A s every ophthalmologist knows, elevated intraocular pressure is a risk factor for glaucoma progression. A prophylactic inferior iridectomy at the time of surgery serves to prevent pupillary block. Glaucoma also can develop after intravitreal injection of silicone oil secondary to pupillary block, inflammation, synechial angle closure, rubeosis iridis, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. Aspiration of a portion of the intraocular gas may be needed, especially if IOP is elevated to a level that may compromise ocular perfusion. Intravitreal injection of expansile gases like sulfur hexafluoride (SF6) and perfluoropropene (C3F8) may produce secondary angle-closure glaucoma with or without pupillary block. Medical therapy and laser iridoplasty are usually successful in controlling IOP, but the presence of conjunctival scarring and recession and retinal hardware after scleral buckling procedures can make surgical management challenging. Angle-closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Intraocular pressure (IOP) elevation has been described after scleral buckling procedures and vitrectomy with intravitreal injection of gas or silicone oil. Secondary glaucoma may complicate retinal detachment surgery.
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