Considerations for refractive surgery in the glaucoma patient

Meleha Ahmad, Isaac Chocron, Anurag Shrivastava

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Purpose of review: Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. Recent findings: Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. Summary: Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.

Original languageEnglish (US)
Pages (from-to)310-315
Number of pages6
JournalCurrent Opinion in Ophthalmology
Volume28
Issue number4
DOIs
StatePublished - Jul 1 2017

Fingerprint

Refractive Surgical Procedures
Glaucoma
Intraocular Pressure
Early Diagnosis
Lasers
Chronic Disease
Observation
Technology

Keywords

  • glaucoma
  • intraocular pressure
  • keratorefractive surgery
  • refractive surgery

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Considerations for refractive surgery in the glaucoma patient. / Ahmad, Meleha; Chocron, Isaac; Shrivastava, Anurag.

In: Current Opinion in Ophthalmology, Vol. 28, No. 4, 01.07.2017, p. 310-315.

Research output: Contribution to journalReview article

Ahmad, Meleha ; Chocron, Isaac ; Shrivastava, Anurag. / Considerations for refractive surgery in the glaucoma patient. In: Current Opinion in Ophthalmology. 2017 ; Vol. 28, No. 4. pp. 310-315.
@article{fe75ed4363d34cf185312f505a3cd5ac,
title = "Considerations for refractive surgery in the glaucoma patient",
abstract = "Purpose of review: Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. Recent findings: Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. Summary: Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.",
keywords = "glaucoma, intraocular pressure, keratorefractive surgery, refractive surgery",
author = "Meleha Ahmad and Isaac Chocron and Anurag Shrivastava",
year = "2017",
month = "7",
day = "1",
doi = "10.1097/ICU.0000000000000381",
language = "English (US)",
volume = "28",
pages = "310--315",
journal = "Current Opinion in Ophthalmology",
issn = "1040-8738",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Considerations for refractive surgery in the glaucoma patient

AU - Ahmad, Meleha

AU - Chocron, Isaac

AU - Shrivastava, Anurag

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Purpose of review: Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. Recent findings: Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. Summary: Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.

AB - Purpose of review: Given the popularity of keratorefractive surgery, and an aging populous of patients who have undergone these procedures, there is an increasing need for updated management protocols. This is particularly relevant for patients with chronic progressive diseases such as glaucoma, due to the variety of related diagnostic and management challenges inherent to these diseases. Here, we will review the current literature to provide an update on the management of patients with glaucoma who are undergoing, or have had laser ablative refractive surgery. Preoperative testing and eligibility considerations, intraoperative factors, and postoperative observation and follow-up will be discussed. Recent findings: Intraoperative intraocular pressure (IOP) rise during flap creation is associated with low risk of acute complications, and furthermore do not appear to have significant long term effects. Modern technologies have improved our ability to determine accurate IOP after refractive surgery despite postoperative changes in corneal architecture. Furthermore, advances in structural imaging allow for earlier detection of even subtle glaucomatous nerve damage. Summary: Although glaucoma remains a relative contraindication to refractive surgery, it is a safe procedure for many patients with appropriate perioperative management and follow-up. Advancements in diagnostic modalities have allowed for earlier detection of glaucomatous disease, and subsequent earlier intervention when appropriate. Standardized diagnostic algorithms and rigorous perioperative assessment are critical to safe management of glaucoma patients undergoing refractive corneal surgery.

KW - glaucoma

KW - intraocular pressure

KW - keratorefractive surgery

KW - refractive surgery

UR - http://www.scopus.com/inward/record.url?scp=85020418909&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020418909&partnerID=8YFLogxK

U2 - 10.1097/ICU.0000000000000381

DO - 10.1097/ICU.0000000000000381

M3 - Review article

C2 - 28445203

AN - SCOPUS:85020418909

VL - 28

SP - 310

EP - 315

JO - Current Opinion in Ophthalmology

JF - Current Opinion in Ophthalmology

SN - 1040-8738

IS - 4

ER -