Eyeworld

EW CATARACT 39 November 2015 ing of IOP control and an increased need for glaucoma medications after cataract surgery, including those with uveitis, corneal transplants, steroid induced IOP elevations, or antecedent ocular trauma. To some extent, even the success of previous, subsequent, or concomitant glauco- ma filtering surgery can be affected by cataract surgery, depending on when the two procedures were conducted relative to each other, the researchers noted. "Fortunately, there are some newer procedures for glaucoma, such as the iStent (Glaukos, La- guna Hills, Calif.) or MicroPulse Laser Trabeculoplasty (MLT) (Iridex, Mountain View, Calif.), that can be performed with high success during cataract surgery for patients with mild glaucoma. Obviously, patients with glaucoma are at increased risk for experiencing elevated pressure from the use of topical steroids following cataract surgery," said William B. Trattler, MD, Center for Excellence in Eye Care, Miami. Further, cataract surgery pa- tients are often on postoperative eye drops for 3–6 weeks, and these drops can impact the health of the ocular surface. Patients on topical glauco- ma medications can have further exacerbation of their ocular surface health from the additional quantity of preservatives contained in these drops. In this case, Dr. Trattler said the extensive drop treatment can result in an increased risk of com- plaints of ocular surface irritation and blurred vision during the post- operative course. "Glaucoma patients on multi- ple medications can be at increased risk for various issues, so clinicians have to be more vigilant in these patients," Dr. Trattler said. "They are more at risk of having IOP spikes postoperatively, and IOP spikes may impact the health of the optic nerve." In the case of cataract patients without a history of glaucoma, Dr. Trattler said that IOP spikes are typically not that serious as long as they are kept under control. In the event that IOP becomes elevated due to steroid response, "switching to a softer steroid as well as initiating pressure lowering drops will take care of the issue, and patients are basically fine then," he said. EW Reference Turalba A, et al. Cataract surgery outcomes in glaucomatous eyes: Results from the Veterans Affairs Ophthalmic Surgery Outcomes Data Project. Am Journal Ophthalmol. 2015;160(4): 693–701. Editors' note: The physicians have no financial interests related to this article. Contact information Sheppard: (757) 226-8021 Trattler: wtrattler@gmail.com Turalba: aturalba@gmail.com MGD Now in Plain Sight LipiView II with Dynamic Meibomian Imaging (DMI TM ) LipiFlow Activator with Vectored Thermal Pulse (VTP TM ) Dilated & Truncated Meibomian Glands Normal 919-459-4880 | tearscience.com | info@tearscience.com Dry Eye from previously hidden Meibomian Gland Disease impacts your patients' quality of life. We've made a lot of changes... Ask us how we're making the evaluation and treatment of MGD accessible for everyone. Setting the Standard * LipiFlow inner-lid technology has been rigorously studied for safety and effectiveness and provides an affordable treatment for the leading cause of Dry Eye. * 31 peer reviewed reports, including 5 large multi-centered, randomized, controlled studies.

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