Fluctuating IOP after vitrectomy

[Eyeaid]

My husband had a vitrectomy. On the check for IOP after the vitrectomy it was 18 (3 weeks after stopping the steroid drops). The following week it was 38. The retinal specialist gave 2 very strong drops to reduce the IOP. Subsequent to using the drops he went for a check for IOP and it was 15. Three weeks after continuously using the drops on his next checkup the IOP was back at 27.

The retinal specialist seemed to be a loss. He is now recommending a glaucoma specialist. We are not sure what to do.

[JohnHaganMD]

The IOP in everyone’s eye varies about 6-8 points over a 24 hour period although normally not go above 21-22.  The elevated IOP is common problem after vitreous surgery and could be due to: steroid responder, angle closure, inflammation, blood in vitreous or drainainge angle, over-inflation of the vitreous cavity.  

[Eyeaid]

Thanks Dr Hagan!

Currently the drops that were given to may husband are Alphagan and Dorzolamide-timolol.

From doing a lot of reading I understand the best medications are Alphagan-P (morning and afternoon, Azopt (3X/day), and Xalatan (at bedtime). Not sure if you have any opinions on this.

Also I would like to buy a tonometer - Is there one that you recommend?

We have a meeting scheduled with the Glaucoma specialist. Are there any questions I need to ask.

Thanks so much Dr Hagan!

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

Alphagan is less expensive than Alphagan P. The difference is the preservative that is less irritating to some people with the "P" type. The IOP lowering capacity is the same.  Xalatan (latanoprost) is often NOT used after intraocular surgery as it may increase inflammation and swelling in the macula.  Home tonometry  doesn't work for most people (scratched corneas, inaccurate readings, excess anxiety)  discuss with the glaucoma specialist.  I don't use home tonometry for that reason

[Eyeaid]

Dear Dr. Hagan

What are your thoughts on Azopt and Lumigan?

Thank you!

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

Azopt is a great medicine but sometimes expensive.  Lumigan I really dislike because it causes red, inflammed, irritated eye,  permanent dark circles around the eyelids and orbital fat atrophy with sunken in eyes and droopy lids way too often.  Travatan-A is much better, longer acting, lowers IOP more and doesn't cause near the side effects of Lumigan.

[JohnHaganMD]

See the glaucoma specialist.

[Eyeaid]

Thank you Dr. Hagan!

Do you any thoughts on why the IOP has such a variance?

[JohnHaganMD]

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