Viscoelastic-related glaucomas

Area of Science:

• Ophthalmology
• Surgical Innovation
• Ocular Physiology

Background:

• Viscoelastic substances are integral to modern anterior segment surgery, enhancing surgical precision and outcomes.
• However, these agents are associated with a significant risk of postoperative intraocular pressure (IOP) elevation.
• This IOP spike, termed ocular hypertension, can be transient but occasionally severe, posing a threat to optic nerve health.

Purpose of the Study:

• To review the incidence and potential mechanisms of viscoelastic-induced ocular hypertension.
• To discuss current management strategies for elevated IOP following viscoelastic use.
• To explore future directions in mitigating this common surgical complication.

Main Methods:

• Review of existing literature on viscoelastic agents and their impact on postoperative IOP.
• Analysis of physical properties of various viscoelastics and their correlation with IOP elevation.
• Discussion of clinical observations and management protocols for viscoelastic-induced ocular hypertension.

Main Results:

• All currently available viscoelastic agents carry a risk of causing or worsening postoperative IOP elevation.
• Differences in molecular weight, concentration, and viscosity do not consistently predict the likelihood of IOP increase.
• No viscoelastic agent has demonstrated a significantly lower incidence of causing ocular hypertension.

Conclusions:

• Viscoelastic-induced ocular hypertension remains a significant concern in anterior segment surgery.
• Strategies like anterior chamber lavage and ocular antihypertensives can help manage IOP spikes.
• Careful patient selection, monitoring, and tailored glaucoma therapy are crucial, especially for those with pre-existing optic nerve damage.