high, drug-unresponsive IOP after cataract surgery: reasonable to "make new drain"?

I mentioned in a previous post that I had very high IOP (~40) after cataract surgery last Wed, and lots of pigment in the anterior chamber. (Nothing in back.) My IOP was normal before surgery.

My surgeon did an emergency procedure Sat to reposition the sharp-edged Acrysof IOL, and this apparently solved the pigment release issue. The two eyes have almost the same small amount of dispersed pigment now. But the pressure in the operated eye remains unchanged at ~40. And my vision continues to be very foggy from microcapsular edema.

She now wants to open a new "drain" immediately (day after tomorrow) by drilling a hole under the eyelid. The idea is that pigment or something else has blocked the existing drainage channel, but this is merely an educated guess. She says that glaucoma is one of her specialties and so she has done such procedures before.

Is this reasonable? Are there any possible alternative scenarios? Is this operation what you would recommend?

I am taking Azopt, Combigan and Travatan, the pressure is not responding at all to these drops.

She volunteered without prompting to refer me to another glaucoma specialist for a second opinion, and I will do that, but frankly I can get equally good advice or better on this page (except of course you can't do your own examination).

[Michael J Kutryb, MD]

I don't know what to say.  Your case has become so complicated as to become beyond my advice at this stage.  I cannot advise you any further except to possible see a glaucoma specialist for a second opinion.  I think that would be very reasonable.  I cannot tell whether you just have very bad eyes with multiple medical conditions or whether you just had bad surgery or maybe both.  Suggest you see a glaucoma specialist asap.  If your surgeon is adept at treating glaucoma, why wasn't it addressed at the time of cataract surgery rather than after.

MJK MD

[Chuckles960]

Thank you for your input. But as stated in the first post, I did not have glaucoma before the procedure, only afterwards.

I have now had the trab done. I am not happy about it (it's a permanent hole in the eye and an infection magnet) but the second opinion from a glaucoma specialist supported the original surgeon's suggestion to do trab asap. She did it the same night.