Glaucoma Surgery Complications

Glaucoma Surgery Complications
SYMPTOMS Symptoms vary depending on complication: Choroidal detachment (serous or hemorrhagic) - blurry vision, ache, more pain with the hemorrhagic type | Malignant glaucoma (aqueous misdirection) - pain, blurry vision | Hypotony maculopathy - blurry vision | Suprachoroidal hemorrhage - extreme pain, blurry vision | Blebitis/Endophthalmitis - pain, blurry vision, photophobia
SIGNS Signs vary depending on complication: Choroidal detachment (serous or hemorrhagic) - retina/choroid elevation, shallow anterior chamber | Malignant glaucoma (aqueous misdirection) - redness, IOP increase (possibly), shallow anterior chamber, forward shift of the iris-lens diaphragm | Hypotony maculopathy - low IOP, chorioretinal folds, hyperopic refractive shift, possible optic disc swelling, vessel dilation | Suprachoroidal hemorrhage - IOP increase, round choroidal elevation | Blebitis/Endophthalmitis - hypopyon, injection, marked inflammation (vitritis), bleb erosion, bleb leakage, redness
WORK-UP Thorough history | Slit lamp examination | Dilated fundus exam
Manage choroidal detachment with topical cycloplegics/mydriatics (atropine 1% tid) | Topical steroids (Pred Forte 1% qid) | Drainage may be required
Treat malignant glaucoma with: Topical cycloplegics/mydriatics (atropine 1% bid) | IOP-lowering drops (timolol bid) | Nd:YAG laser capsulohyaloidotomy | Vitrectomy
Hypotony maculopathy is best treated by targeting the cause of the IOP decrease (ex. Bleb is the cause, so bleb excision and revision is performed) | Discontinue IOP-lowering drops
Suprachoroidal hemorrhage may be observed or drained
Endophthalmitis requires urgent treatment, including a vitreous tap/cultures and intravitreal and/or intravenous antibiotics/antifungals
FOLLOW-UP Frequently
ADDITIONAL LAB | TESTS OCT mac for choroidal detachment and hypotony maculopathy | UBM for malignant glaucoma
ETIOLOGY Glaucoma surgery
NOTES Blebitis can have a “white-on-red” appearance