cystoid macular edema and glaucoma

[topcat172]

I have 2 eye care MD's. After endopthalmitis, several vitrectomys, 2 patent iridotomys, epiretinal membrane peel etc. my eye pressure remains very high despite medications. My primary opthamologist is more concerned about my high IOP which is in both eyes now (all of the above complications are in left eye) and wants to add more glaucoma meds. My retina specialist is not concerned about high IOP and is more concerned about CME treatment and while he did agree to lower steroid drop does not want another glaucoma drop added. I use Trusopt and Alphagan and cannot use Beta- Blockers. Which condition has the most risk of causing serious and irreversible vision loss? They do communicate with each other but do not agree with treatment plans. I am the one who has to decide which MD to listen to. Please give me an opinion because I do not know what to do. My vision in left eye is hand motion only and vision in right eye seems to be getting worse. Thanks!

[Michael J Kutryb, MD]

It depends on how high the pressure is.  If it is above 25 or 30 you could literally lose all your vision before too long.  CME will make vision very blurry.  High pressure can make you totally blind in that eye depending on how high the pressure and how long it is elevated.  If pressure was above 30, the damage would occur much quicker.  It might be possible for the eye to tolerate pressure in the 20's for some time, if the treatment for the CME is working.  It's a classic damned if you do, damned if you don't and takes a lot of skill  and patience from the doctor to navigate between the scylla and charybdis.  In general, the pressure will always need to be respected and reckoned with.  Elevated pressure could be the final downfall in the end if not fixed.

Michael Kutryb, MD

[jan17]

Thank you for the great explanation about pressure because I never quite understood what was high, damaging, etc

[topcat172]

  Thanks for answering but I have a few more questions, Is it possible for someone to have an eye pressure very high (mine was 38 in left and 32 in right eye on Monday and by Friday it was 44 in left and 42 in right ) without it causing any damage at all? Can some people withstand greater eye pressure than others? This is with use of several glaucoma meds. My retina MD says all damage done to left eye goes back to post surgical endophthalmitis and 8s not too concerned while my regular opthalmologist and two of his fellow doctors in same practice say this is unacceptable. My regular opth. keeps adding eye drops and so has one of the MDs in his practice but they are always ones that my primary care physician says not to use because of asthma and low-blood pressure. I have had severe reactions in the past. Friday I was told that I had nothing wrong with my retina except that it is too thin in left eye which is eye retina specialist says is so damaged by the past infection. I think I have too many doctors and the retina specialist is the only one who seems to have my chart up to date. Most of the time when I go see reg. opthamologist he is unaware of 90% of what retins MD has done. My pupil stays dilated and fixed in left eye s8ince 8infection in Feb. My right eye sometimes dilates and pressure is very high but angles are open. I have had 6 surgeries since Feb all done by retina specialist except for the cataract surgery and 2 laser iridotomys. I have come to the conclusion that I should only see retina specialist and not return to other eye MD because i am able to tell myself when my eye pressure is very high and as I stated earlier other than headache and nausea when pressure gets very high there is no evidence that either of my eyes have been damaged by the pressure.Damage in left eye was done by endopththalmitis. I did have ocular hypertension and pigment dispersia in both eyes prior to cataract surgery. I am a relatively young woman and the past 4 months are taking a toll on me and things get worse instead of better. I am not using any drops that would dilate my eyes and have had an MRI to rule out any other problems. i have asked you many questions before and always appreciate your opinions. Thanks for your help!

[Michael J Kutryb, MD]

Pressure of 42 probably would likely eventually cause serious damage and perhaps eventually even total blindness in most eyes (and of course yours is in a very weakened state) so I would be very concerned.  32 might be tolerated by some stronger eyes for some time.

MJK MD