Eyeworld

SPRING 2026 | EYEWORLD | 97 G Contact Radcliffe: drradcliffe@gmail.com Trubnik: vtrubnik@ocli.net Relevant disclosures Radcliffe: Alcon, Allergan, Glaukos, New World Medical, Sight Sciences Trubnik: Glaukos their target pressure on day 1, then you start to worry," Dr. Trubnik said. If the pressure is below 30 mm Hg, she gives them a drop in the office, or if they have higher risk factors, she may give them a sample drop or prescribe a fixed-dose combination drop to take at home for a few days. Dr. Radcliffe said that typically a clinically meaningful IOP spike is one that is 10 mm Hg or more above baseline. "For me, a clinically meaningful IOP spike is an intraocular pressure in the postoperative period, which if sustained for a week or so, would be likely to cause damage to the patient's optic nerve and vision," he said. He added that he has a low threshold for introducing a topical therapy, especially if given in the office. In patients with glaucoma or glaucoma suspects whose pressure goes above 35 mm Hg, who might have microcystic edema, a headache, and/or blurry vision, Dr. Trubnik treats with a paracentesis in the office. "We call it 'burping the wound' to get any retained viscoelastic out," she said. "I find that after you do the paracente- sis first, they respond to the topical drops much better." She may give these patients a couple doses of oral acetazolamide as well. Dr. Radcliffe also advocated for a paracen- tesis on postop day 1, especially for pressures at 30 mm Hg or above. "There's a couple of reasons why the anterior chamber paracentesis is reasonable in this setting. One is that I think that once the pressure is high, the pressure drops don't get absorbed as well, and it creates a cycle. Lowering the pressure with an AC para- centesis and applying a round of drops can do a good job of keeping the pressure down. Addi- tionally, if there is retained viscoelastic, letting fluid out of the anterior chamber will get rid of some of that retained viscoelastic," he said. Oral agents, if he hasn't given them prophy- lactically, Dr. Radcliffe reserves for patients who have had a paracentesis and topical therapy and whose pressure is still high or even climbing upon reassessment. If a pressure spike occurs due to a steroid response in the days to weeks after cataract surgery, Dr. Trubnik said the patient needs to be weaned off the steroid, which can take weeks and require a bridge with an NSAID. "We want to prevent CME postop, but we also want to get them off the topical steroid to reduce their IOP. You're stuck between a rock and a hard place. It helps to wean these patients off slowly. It's been rare that I have had to resort to surgical intervention for someone who had an IOP spike, whether within the first 24 hours or days to weeks later." If weaning a patient off of steroids doesn't help, there could be a retained nuclear frag- ment, which Dr. Trubnik said is rare. "Don't be afraid to do gonioscopy to look for retained fragments," she said. "I think the comprehensive or anterior segment surgeon who doesn't typically do glaucoma can get very concerned about what to do with these patients," Dr. Trubnik said. "It's important to be patient with them." Dr. Trubnik said she tells all her cataract pa- tients that if they experience changes in vision or headache to call the office because it may be a sign of raised intraocular pressure. Overall, Dr. Radcliffe said it's also import- ant to recognize that some glaucoma patients have such damaged outflow systems that even a normal cataract surgery can overwhelm the trabecular meshwork and cause sustained IOP spikes. "I think this occurs all the time, even if a trabecular MIGS procedure is performed at the same time as a cataract surgery. In some cases, the IOP spike may just be, with or without a previous history of glaucoma, declaring that it has trouble regulating its intraocular pressure," Dr. Radcliffe said, which can be a first sign that an eye is developing glaucoma. Mary Qiu, MD, EyeWorld Glaucoma Editorial Board member, shared what she is looking forward to at the 2026 ASCRS Annual Meeting: "I'm looking forward to meeting all the young eye surgeons and sharing my tips about glaucoma and cataract surgery with them!"

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