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Q&A with Australian Health Practitioners
Am I at risk of more acute glaucoma attacks?
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I recently had 2 acute glaucoma attacks. Both were immediately following laser iridotomy. I now need lens replacement. Am I at risk for further acute glaucoma attacks following this surgery? I understand that with the previous attacks my eye had made a lot of proteinous material following iridotomy which led to these attacks. -
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An attack of high pressure in the eye can be caused by many things. Usually a peripheral iridotomy will reduce the risk of this happening in cases of angle closure (where the normal drainage part of the eye blocks off) by approximately 10 fold. However, if there is a large cataract, even after the laser treatment there may not by physically enough room in the eye to open the drain again and removal of the cataract is indicated. If there is also proteinaceus material in the eye post iridotomy, it is often advisable to let this settle down first unless the eye pressure is really out of control.Once a lens has been removed, there is physically more room in the eye usually. There may be some residual scar tissue from previous angle closure (synechiae) that may still be clogging the normal drainage angle. This is sometimes addressed at the time of cataract surgery (called goniosynechialysis). It is best to talk to your ophthalmologist about this as it is a relatively specialised procedure. It is extremely unlikely post cataract surgery that you would have another acute attack of high pressure but you may have chronically elevated pressure requiring pressure lowering medications postoperatively. This eventuality is extremely difficult to predict and it may not be clear until a few weeks post surgery whether this will be needed or not.
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