Anurag Shrivastava1, Assumpta Madu, Jeffrey Schultz. 1. Department of Ophthalmology, Glaucoma Service Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA. ashrivas@montefiore.org
Abstract
PURPOSE OF REVIEW: Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucoma patients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols. RECENT FINDINGS: As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested. SUMMARY: As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
PURPOSE OF REVIEW: Patients considering corneal refractive surgery undergo extensive preoperative testing, but current protocols may not address the management of glaucoma appropriately. This review outlines the current body of literature on the diagnostic and management challenges that exist in the treatment of glaucomapatients undergoing laser ablative surgery, and makes recommendations to improve current perioperative protocols. RECENT FINDINGS: As permanent structural alterations to the cornea after laser-assisted in-situ keratomileusis surgery make Goldmann applanation tonometry inaccurate, the advent of new diagnostic modalities and recommendations to accurately measure postoperative intraocular pressure (IOP) and subtle damage to the optic nerve have been further analyzed and tested. SUMMARY: As IOP is the only modifiable risk factor in the treatment of glaucoma to date, traditional diagnostic and treatment algorithms may not be appropriate for refractive surgery patients. Glaucoma remains a relative contraindication to refractive procedures, but as new diagnostic modalities emerge, our ability to diagnose and manage these patients may improve. More uniform recommendations need to be implemented to improve our long-term management of these patients.
Authors: Joshua S Hardin; Christopher I Lee; Lydia F Lane; Christian C Hester; R Grant Morshedi Journal: Graefes Arch Clin Exp Ophthalmol Date: 2018-07-23 Impact factor: 3.117
Authors: Maja Zivkovic; Vesna Jaksic; Athanassios Giarmoukakis; Michael Grentzelos; Marko Zlatanovic; Gordana Zlatanovic; Aleksandra Miljkovic; Svetlana Jovanovic; Miroslav Stamenkovic; George Kymionis Journal: Biomed Res Int Date: 2017-09-05 Impact factor: 3.411