Glucoma test ...IOP 24 on both eyes 23 days after cataract surgery

[vamali]

Dear Doctor John C Hagan III, MD, FACS  ,


As I mentioned earlier my wife underwent cataract surgery on the 9th April 2011

Procedure done: Micro Incision Cataract Surgery with Foldable Intra Ocular Lens Implantation Done on the Left Eye.

Yesterday the 3rd May We went to the same hospital and had the second review with the doctor.  Even yesterday , after 23 days of surgery, the IOP was 24 on both eyes( She is still on , Prednisolone Acetate Opthalmic Suspension USP1 , TWICE a day this week and once a day next week.

The hospital suggested to have a Glucoma test.  Her vison is perfect and the same doctors during all the consulatations confirmed that the neves are in perfect order and no problems at all.  Her visiion is extremely good on the left eye for which the surgery was done. She has cataract in the right eye too.  The IOP on both eyes readin 24 is my concern.  Please educate me and help me with your expert opinion.

Here in my country most of the hospitals, on knowing that the insurance company pays the bill for treatment, will suggest so many tests.

When I asked the doctor who suggested Glucoma test, he said that he wants to rule out the possibility og Glucoma and hence asked for the test.  Is is necessary to under go this test.

I shall be thankful for your opinion and suggestions

Thanks and best regards
A.Mohamed Ali
Chennai India

[John C Hagan III, MD, FACS, FAAO]

No that would not cause glaucoma or increase IOP

JCH MD

[vamali]

Dear Dr  John C Hagan III, MD, FACS,

thanks a lot for your informative reply.

One thing I forgot to tell you is that my wife suffered from DVT ( Deep vein Thrombosis) in the year 2002 and she was treated by a doctor friend of mine( who is a vascular surgeon and Head/Trustee  of a very famous Hopital in Chennai. She was given Feparin/Warfarin those days to dilute the blood and a to bring the INR to normal . At that time,the doctors told me that the only side effect might be an earlier cataract.

Is the IOP due to that?  

I shall be thankful for your reply.

Thanks nd best regards

A.Mohamed Ali
Chennai

[John C Hagan III, MD, FACS, FAAO]

It is possible that she might be a "steroid responder" and that the increase in IOP is due to the use of the prednisolone. 24 is not that high. One option would be to stop the steroid and wait a couple of weeks to see if the IOP returns to normal. If she needs surgery on the other eye non-steroidal antiinflammatories might be used or a steroid less likely to raise the IOP (Lotemax).

If there is no strong family hx of glaucoma and the optic nerve looks good (not large cup/disk ration) then waiting may make good sense.

JCH MD