This retrospective review found that preoperative aphakic glaucoma could be a significant risk factor for early postoperative IOP spikes in children undergoing secondary IOL implantation. The authors recommend close monitoring of IOP during the early postoperative period and the consideration of additional prophylactic anti-glaucoma medication for children with aphakic glaucoma.
They reviewed the charts of 85 children (133 eyes; mean age, 14.3 years) who underwent secondary IOL implantation by the same surgeon.
Six of the nine eyes that developed an IOP spike (IOP > 26 mmHg) on postop day one had preoperative aphakic glaucoma. These six eyes comprised 27 percent of the total eyes with preoperative aphakic glaucoma, compared to three eyes without glaucoma (3 percent) that developed a spike (relative risk, 10.1).
Fortunately, no patient in this study required glaucoma surgery to regain control of their glaucoma. After the temporary postoperative IOP spike was managed, the IOP in all patients returned to preoperative levels and none needed additional medications. For these reasons, the authors do not recommend glaucoma surgery preoperatively or concurrent with IOL implantation when glaucoma is controlled with medications.
They note that due to the inherent difficulty of measuring IOP in infants and children, an elevated IOP may have occurred in more children without being discovered during the postoperative day one examination. Because of this, they cannot determine the precise incidence of early IOP spike.
However, the high incidence of postoperative day one IOP spikes in patients with aphakic glaucoma warrants meticulous ophthalmic viscosurgical device (OVD) removal at the end of surgery. Bimanual irrigation/aspiration (I/A) techniques facilitate the evacuation of OVD. The authors use a pair of handheld I/A hand pieces, but an anterior chamber maintainer also works well.
Even with careful attention to surgical details, patients with controlled aphakic glaucoma appear to be at increased risk for a potentially dangerous IOP spike during the first 24 hours after secondary IOL implantation surgery.
They recommend routine use of prophylactic topical and/or systemic glaucoma medication during the early postoperative period after secondary IOL implantation in aphakic glaucomatous eyes. If a patient is already on glaucoma medications, they advise the use of additional medication and close monitoring of postoperative IOP.