A Rise in Intraocular Pressure after a Successful Canaloplasty and Goniotomy

Additional Authors

J. Hassan Syed, Quillen College of Medicine, East Tennessee State University, Johnson City, TN Abigail N. Horrar, Quillen College of Medicine, East Tennessee State University, Johnson City, TN

Abstract

Glaucoma is a group of eye disorders causing progressive optic neuropathy, leading to visual field loss and potential blindness. Surgical options include trabeculectomy, tube shunts, laser trabeculoplasty, and minimally invasive glaucoma surgery (MIGS.) This case involves a 79-year-old male with open-angle glaucoma who underwent canaloplasty (180°) and goniotomy (270°) on his left eye. The 79-year-old male, with a history of glaucoma, presented to the veterans' affairs (VA) hospital with increased intraocular pressure (IOP) and vision loss. Despite using Latanoprost and Brinzolamide-Brimonidine eye drops, IOP control was inadequate. Pre-operative IOP was 18 mmHg in the left eye. Subsequent visits showed elevated pressure in the left eye and continued visual field loss. He underwent surgery, and a week later had his lowest IOP in 3 years off all IOP drops, 13 mmHg. One month after surgery his IOP was 10 mmHg off all drops. However, IOP later reverted to pre-operative levels (12–22 mmHg) and he resumed his prior eye drop regimen. More aggressive treatment did not resolve the elevated IOP as the patient was unable to tolerate the addition of a IOP-lowering topical drop, the rho kinase (ROCK) inhibitor, netarsudil. Risk factors for failure include elevated pre-operative pressure, previous visual field loss, and prior use of aqueous suppressants containing benzalkonium chloride (BAK). Given a history of intolerance to multiple topical drops, future options for increasing medical therapy are limited for this patient and other surgical options should be considered if his glaucoma continues to worsen. Although initial post-operative IOPs may decrease following canaloplasty and goniotomy, long-term monitoring and follow-up may be required in patients with risk factors of failure, such as in this patient, to ensure therapeutic IOPs are achieved.

Start Time

16-4-2025 1:30 PM

End Time

16-4-2025 4:00 PM

Presentation Type

Poster

Presentation Category

Health

Student Type

Clinical Doctoral Student (e.g., medical student, pharmacy student)

Faculty Mentor

Brent Aebi

Faculty Department

Surgery

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Apr 16th, 1:30 PM Apr 16th, 4:00 PM

A Rise in Intraocular Pressure after a Successful Canaloplasty and Goniotomy

Glaucoma is a group of eye disorders causing progressive optic neuropathy, leading to visual field loss and potential blindness. Surgical options include trabeculectomy, tube shunts, laser trabeculoplasty, and minimally invasive glaucoma surgery (MIGS.) This case involves a 79-year-old male with open-angle glaucoma who underwent canaloplasty (180°) and goniotomy (270°) on his left eye. The 79-year-old male, with a history of glaucoma, presented to the veterans' affairs (VA) hospital with increased intraocular pressure (IOP) and vision loss. Despite using Latanoprost and Brinzolamide-Brimonidine eye drops, IOP control was inadequate. Pre-operative IOP was 18 mmHg in the left eye. Subsequent visits showed elevated pressure in the left eye and continued visual field loss. He underwent surgery, and a week later had his lowest IOP in 3 years off all IOP drops, 13 mmHg. One month after surgery his IOP was 10 mmHg off all drops. However, IOP later reverted to pre-operative levels (12–22 mmHg) and he resumed his prior eye drop regimen. More aggressive treatment did not resolve the elevated IOP as the patient was unable to tolerate the addition of a IOP-lowering topical drop, the rho kinase (ROCK) inhibitor, netarsudil. Risk factors for failure include elevated pre-operative pressure, previous visual field loss, and prior use of aqueous suppressants containing benzalkonium chloride (BAK). Given a history of intolerance to multiple topical drops, future options for increasing medical therapy are limited for this patient and other surgical options should be considered if his glaucoma continues to worsen. Although initial post-operative IOPs may decrease following canaloplasty and goniotomy, long-term monitoring and follow-up may be required in patients with risk factors of failure, such as in this patient, to ensure therapeutic IOPs are achieved.