Complications from LTP include inflammation, IOP spike, and pain. IOP elevations are of particular concern in patients with advanced glaucoma. Such increases are usually evident by the first hour postoperatively. The adjunctive use of topical apraclonidine or brimonidine has been shown to blunt postoperative pressure elevation. Other medications that can reduce IOP spikes include β-blockers and pilocarpine. Hyperosmotic agents and oral carbonic anhydrase inhibitors may be helpful in eyes with IOP spikes not responsive to topical medications. In rare cases, patients have prolonged, intractable IOP elevation requiring incisional surgery. Treatment of 180° can decrease the risk of postoperative IOP spikes, especially with ALT.
With ALT, PAS can form if the laser is applied too posteriorly. Low-grade anterior segment inflammation can occur after treatment with any LTP method. Other complications include hyphema and reactivation of herpes simplex virus. In rare cases, patients can develop keratitis leading to irregular astigmatism.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.