Eyeworld

94 | EYEWORLD | SPRING 2026 G UCOMA by Liz Hillman Editorial Co-Director About the physicians Nathan Radcliffe, MD New York Ophthalmology New York Eye Surgery Center New York, New York Valerie Trubnik, MD, FACS OCLI Vision Manhasset and Mineola, New York said. "If you have an average cataract patient and they have minimal risk factors for IOP spikes, I think it's OK to see them the following day, which is what I do for my patients. If you're concerned about someone having glaucoma or significant risk factors, it's possible to bring them back the same day to measure their pres- sure, but I've been practicing in glaucoma for a long time, and I can't remember the last time I've done that. Most of the time, it's OK to bring the patient in the morning of the following day and check their pressure." Dr. Radcliffe reserves same-day pressure checks for patients who already have severe optic nerve damage and whose visual fields are severely constricted. "That said, many of those patients in my practice are getting a surgery designed to reduce the pressure," he said. "So realistically, the patients who are most in need of same-day IOP checks are people who have severe glaucoma, but for one reason or another, are not getting a trabeculectomy or a non- valved tube shunt because they have the risk of nerve damage, but their cataract surgery was not accompanied by a filtration surgery." In addition to preexisting or undetected glaucoma, the following factors can increase risk for a postop pressure spike, according to Dr. Trubnik: male gender, high myopia, history of exfoliation syndrome, shallow anterior cham- ber, short axial lengths, and thicker lenses. Dr. Radcliffe added that complex cataract surgery G laucoma specialists say they're often referred post-cataract surgery patients experiencing an IOP spike, many of whom could be treated by the referring surgeon. EyeWorld spoke with two glaucoma specialists to get their insights on what to watch for and management of these cases. "It can be a common frustration for cata- ract surgeons to have a cataract patient with sustained IOP elevation after cataract surgery," said Nathan Radcliffe, MD. "The surgeon should understand that this is a rare event but that it does happen. It doesn't mean anything went wrong with the surgery. In my opinion, it's just the eye declaring that it has a problem with tra- becular outflow that had not manifested yet. I have cared for many patients who were referred to me with this problem, and sure enough, if we follow that patient long enough, the fellow eye, whether it's had cataract surgery or not, usually ends up getting glaucoma." Who's at risk? Valerie Trubnik, MD, FACS, said the average cat- aract patient with minimal risk factors for IOP spikes can be seen the day following surgery. However, she noted, most IOP spikes after this procedure are more common in the first 8–12 hours. "Most of us are not seeing our patients during that time, so in terms of detecting an IOP spike, I would say it's usually at 24 hours," she IOP spikes after cataract surgery: insights from glaucoma specialists continued on page 96 continued from page 93 ECD loss can be accelerated by glaucoma sur- gery, so the positioning of any suprachoroidal device will need to be appropriate." 5,6,7 She said it's also important to be cognizant of the patient's stage of glaucoma and current medications. Acute cleft closure with severe pain seems to be less common with these proce- dures, but if a suprachoroidal stent fails and the cleft closes, the patient's pressure can increase significantly. "It is prudent to keep patients on their medications if preoperative IOP is high, especially a prostaglandin analog (which will increase uveoscleral outflow) after surgery," Dr. Schehlein said. Some surgeons may also consid- er placing the patient on pilocarpine postopera- tively with the goal of maintaining the cleft. Dr. Schehlein added that patients can some- times have more sensation during procedures in the supraciliary space, and it may be necessary to give additional systemic anesthesia and/or consider a sub-Tenon's or retrobulbar block.

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