Systemic Side Effects of Glaucoma Medications

Lama, Paul

doi:10.1007/978-0-387-76700-0_59

Cited by 1 publication

(2 citation statements)

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“…Miotics are commonly used at the conclusion of cataract surgery to retract a floppy iris from the incision 26 or to secure a sulcus lens implant after a complex cataract surgery 27 . It is, therefore, not surprising that ab interno glaucoma surgeons resort to the same medications despite reports of worsening of iritis 28 , 29 , retinal detachment and further angle narrowing, as the most serious complications 19 – 23 . Interestingly, a narrow angle is not a contraindication to trabectome surgery and yields similar results to wide angles 6 .…”

Section: Discussionmentioning

confidence: 99%

“…However, a TM-mediated IOP effect, for instance by adding cataract surgery, becomes negligible after trabectome surgery 17 , 18 , because the aqueous can bypass the remaining TM. Patients dislike miotics because of their side effects of headaches, nearsightedness, dim vision and more serious problems that include retinal detachment, worsening intraocular inflammation, paradoxical increase in IOP and cataract formation 19 – 23 .…”

Section: Introductionmentioning

confidence: 99%

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Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

et al. 2018

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Background: Pilocarpine is commonly used after angle surgery for glaucoma despite a host of side effects and risks. We hypothesized that a pharmacological miosis during the first two months does not improve short- and long-term results of trabectome-mediated ab interno trabeculectomy. Methods: In this retrospective comparative 1-year case series, we compared 187 trabectome surgery eyes with (P+) or without (P-) 1% pilocarpine for two months. Primary outcome measures were the surgical success defined as intraocular pressure (IOP) ≤ 21 mmHg and decreased ≥ 20%, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, and IOP. Results: We categorized 86 (46%) eyes as P- and 101 (54%) eyes as P+. The mean age was 69.8±10.1 in P- and 70.5±9.4 in P+ (P=0.617) with equal gender distribution (P=0.38). The cumulative probability of qualified success at 12 months was 78.1% in the P- and 81% in the P+ (P=0.35). The IOP was decreased significantly from 20.2±6.8 mmHg at baseline to 15.0±4.8 mmHg at 12 months follow-up in P- (P=0.001) and 18.8±5.3 and 14.7±4.0, respectively (P=0.001). The medications decreased significantly from 1.4±1.2 in P- and 1.4±1.2 in P+ at baseline to 1.0±1.2 and 0.7±1.0, respectively (P=0.183). P- and P+ did not differ in IOP or medications (all P>0.05). In Multivariate Cox Regression models, the baseline IOP and central corneal thickness were associated with failure. Conclusions: Use of postoperative pilocarpine does not improve the efficacy of trabectome surgery.

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