Management
Perioperative Care in Incisional Glaucoma Surgery
e ophthalmologist who performs incisional glaucoma surgery has the following
responsibilities:
• Obtain informed consent from the patient or the patient's surrogate decision maker
after discussing the risks, benefits, and expected outcomes of surgery
• Ensure that the preoperative evaluation accurately documents the findings and
indications for surgery
• Prescribe topical corticosteroids in the postoperative period
• Perform a follow-up evaluation on the first postoperative day (12–36 hours after
surgery) and at least once during the first 1–2 weeks to evaluate visual acuity, IOP, and
status of the anterior segment
• In the absence of complications, perform additional postoperative visits during a
3-month period to evaluate visual acuity, IOP, and status of the anterior segment
• Schedule more frequent follow-up visits, as necessary, for patients with postoperative
complications such as a flat or shallow anterior chamber or evidence of early bleb
failure, increased inflammation, or Tenon's cyst (encapsulated bleb)
• Undertake additional treatments as necessary to improve aqueous flow into the bleb
and lower IOP if evidence of bleb failure develops, including injection of antifibrotic
agents, bleb massage, suture adjustment, release or lysis, or bleb needling
• Manage postoperative complications as they develop, such as repair of bleb leak or
reformation of a flat anterior chamber
• Explain that filtration surgery places the eye at risk for endophthalmitis for the
duration of the patient's life, and that if the patient has symptoms of pain and
decreased vision and the signs of redness and discharge, he or she should notify the
ophthalmologist immediately (III, G, S)
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