Bleb Infection (Blebitis)
See 9.19, BLEBITIS.
Increased Postoperative IOP After Filtering Procedure
Grade of Shallowing of Anterior Chamber
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Please be sure to differentiate anterior chamber shallowing grading from both the Shaffer grading classification of angle depth and the Van Herick method for angle chamber estimation, all of which use numerical systems for grading. See Appendix 14, ANGLE CLASSIFICATION. |
Differential Diagnosis
(See Table 9.18.1.)
If the anterior chamber is flat or shallow and IOP is increased, consider the following:
If the anterior chamber is deep, consider the following:
9-18.1 Postoperative Complications of Glaucoma Surgery
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Treatment
Initial gonioscopy to assist in diagnosis is essential before starting any treatment.
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If the sclerostomy is blocked with iris, any pressure on the globe is contraindicated due to potential for further iris incarceration. |
Low Postoperative IOP After Filtering Procedure
Low pressures (<7 to 8 mm Hg) can be associated with complications such as flat anterior chamber, choroidal detachment, and suprachoroidal hemorrhage. An IOP <4 mm Hg is more likely associated with complications including macular hypotony and corneal edema.
Differential Diagnosis and Treatment
Complications of Antimetabolites (5-Fluorouracil, Mitomycin C)
Corneal epithelial defects, corneal edema, conjunctival wound leaks, bleb overfiltration, bleb rupture, scleral thinning and perforation, and increased risk of blebitis.
Complications of Cyclodestructive Procedures
Pain, uveitis, decreased vision, cataract, hypotony, scleral thinning, choroidal effusion, suprachoroidal hemorrhage, sympathetic ophthalmia, and phthisis.
Miscellaneous Complications of Filtering Procedures
Cataracts, corneal edema, corneal delle, endophthalmitis, uveitis, hyphema, and bleb dysesthesia (discomfort).
Miscellaneous Complications of Tube-Shunt Procedures
Cataracts, corneal edema, endophthalmitis, hyphema, scleral perforation, diplopia, and tube/implant erosion.