Can you please discuss what is done to insure that secondary glaucoma
won't be a result of cataract surgery since, as I understand it, the aqueous and
eye pressure are interrupted as a result of the surgical procedure; therefore, how
is the pressure restored to normal and does it stay normalized or can either the IOL
or something else cause complications with eye pressure.
This is a difficult question to answer without more specifics. Cataract surgery usually lowers eye pressure a little bit long term and not elevate it unless there are problems from the lens that occasionally lead to a secondary pigment dispersion glaucoma or what is called UGH syndrome (uveitis, glaucoma, hyphema). I'm assuming you are asking about the immediate post-operative period. Occasionally, eye pressure shoots up within the first 72 hours after cataract surgery for one of multiple reasons. This is more likely to happen in people who have underlying glaucoma to begin with. In those with severe visual field deficits already and damaged optic nerves, eye pressure should either be checked in the afternoon of the same day as the cataract surgery or pills could be given to decrease the chance of a pressure spike. This all needs to be discussed with your surgeon. The first possibility should not occur if the surgeon is experienced and places the lens in the correct location.
Thank you Dr. Vosoghi for your response to my concerns about secondary glaucoma post op cataract surgery. The information you gave was extremely helpful and much appreciated.
I had one follow up question for you - can you briefly describe what's happening in the eye relative to the flow of aqueous at the point when the corneal incision is made, then during the phaco phase of the procedure, and onto the implanting of the IOL?
Does the aqueous 'turn off' and if so, how do you re-establish it so that the fluid flow/pressure become normalized.
Once the eye is open and throughout the procedure the surgeon controls the pressure in the eye with the inflow of fluid through the instruments (phaco tip) and outflow around the instruments and through the suction associated with the phaco. This leads to some fluctuations up and down but should be consistantly below a maximum threshold that the surgeon sets using a bottle height. Compared to this artificial inflow-outflow system, the normal production of aqueous and outflow through the natural drain of the eye (trabecular meshwork) is inconsequential (the eye continues to make fluid and drain it at a much slower rate of a coupld of microliters per minute).
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