Care After Glaucoma Surgery
Chat Highlights
April 24, 2002

Norma Devine, Editor

On Wednesday, April 24, 2002, Dr. Elliot Werner, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Care After Glaucoma Surgery."

Moderator:  Welcome back, Dr. Werner.  Tonight we're discussing care after glaucoma surgery.  

P:  Dr. Werner, what are the restrictions after a trab (trabeculectomy)?  

Dr. Elliot Werner:  Strenuous activity is usually limited for a couple of weeks.  Otherwise, there is not much restriction of activities. 

P:  What are the most common mistakes people make after a trab? 

Dr. Elliot Werner:  Not using their medications as instructed, not keeping their doctor appointments, and not calling the doctor if something is wrong.

P:  What advice would you give the spouse of a patient who has had a trab?  

Dr. Elliot Werner:  The spouse needs to be patient and provide support.  The patient may not see very well for some time and might need help with some activities.  The spouse should help monitor the medications and prevent the patient from getting mixed up about the drops.  

P:  What effect does straining have on the operated eye?  

Dr. Elliot Werner:  Straining increases the risk of hemorrhage and breaking open the surgical wound.

P:  How long after a trab should a parent wait before bending over to pick up toys and lifting children?

Dr. Elliot Werner:  Brief bending is probably okay within a day or two.  Prolonged bending is the problem.  I would wait about two weeks before lifting heavy objects.  Remember, too, that very young children and infants sometimes poke you in the eye.  

P:  How should children be handled after trabs? 

Dr. Elliot Werner:  Infants require careful parental supervision.  Very young children can be patched or shielded during the immediate post-op period.  Their care requires a lot of cooperation and supervision by the parents. 

P:  Three days after my two-year-old son's trabeculectomy for glaucoma, someone played pretty rough with him, held him upside down, etc.  Could such activity have any negative effects on his eye?  

Dr. Elliot Werner:  Yes.  You should not have allowed it.

P:  Is the recovery period the same for children as for adults?  

Dr. Elliot Werner:  In general, children recover faster from everything than adults, but childhood glaucoma is often more severe and resistant to treatment.  That complicates the recovery.

P:  How long after a trab should a patient wait before having sex?  

Dr. Elliot Werner:  Sexual activity without a lot of vigorous or strenuous movement is probably okay after a few days.

P:  Should alcohol consumption be limited post-op?

Dr. Elliot Werner:  Moderate use of alcohol -- a glass of wine or a beer with dinner-- is probably not a problem.  Getting drunk increases the risk of injury and of forgetting to use the medication.  It impairs judgment, so should be avoided.

P:  Should smoking cigarettes and second-hand smoke be avoided?  

Dr. Elliot Werner:  Smoking should be avoided at all times, everywhere and by everybody in every circumstance.  It is never good, but there is no known acute adverse effect of smoking during the post-op period, other than irritation and discomfort of the eye. 

P:  How soon would flying be okay post-op? 

Dr. Elliot Werner:  Flying in a commercial airliner is probably okay after a day or two.  Flying is only a problem after certain types of retinal surgery when gas has been placed in the eye.  

P:  Is there any increased risk of infection after the surgery has healed?

Dr. Elliot Werner:  There is a significant risk of infection lifelong after filtering surgery.  It has been shown that late infections, months or even years later, occur in perhaps as many as 5% of patients after glaucoma surgery.

P:  What are some signs of inflammation or infection?  

Dr. Elliot Werner:  Pain, increasing redness, eyelid swelling, decreasing vision over time, and discharge from the eye.

P:  If the risk of infection is lifelong, does that mean I should never wear contact lenses again?

Dr. Elliot Werner:  Most patients can wear contacts, especially soft lenses, after surgery.  You should only use daily wear lenses and be meticulous about cleaning and disinfecting them daily.  

P:  Why is Pred Forte used on the eye after surgery?  

Dr. Elliot Werner:  Steroids are used post-op to reduce inflammation and scarring.  A number of studies have shown that the use of steroids after glaucoma surgery is associated with a higher success rate.

P:  Is it true that there is usually a diminution of vision permanently after a trabeculectomy?  

Dr. Elliot Werner:  Not necessarily, but it has been shown that up to 50% of patients lose some vision after glaucoma surgery.  The most common cause is the development of cataracts.  

P:  I am having ALT (argon laser trabeculoplasty) surgery tomorrow and I am scared.  Is the surgery preformed on both eyes during the same visit?  

Dr. Elliot Werner:  ALT is a very safe procedure, with virtually no complications.  Most doctors do not do the surgery on both eyes on the same day.

P:  Is there any way to tell that a trab has stopped working, other than by routine pressure checks?  

Dr. Elliot Werner:  Not really, unless you can check your own pressure with your finger through the closed eyelids and tell how hard your eye is.

P:  How long after a trab is it safe to resume activities such as swimming?  

Dr. Elliot Werner:  Swimming is a problem.   I usually advise waiting about six weeks and then wearing swimmers' goggles.

P:  How long does a droopy eyelid last after a trab? 

Dr. Elliot Werner:  The ptosis generally goes away in about three months, but may last longer, or even be permanent.

P:  My ptosis is permanent. 

P:  Is the risk of cataract surgery greater after having had a trab and also laser for a torn retina?

Dr. Elliot Werner:  Any previous surgery or eye disease always increases the risk of cataract surgery.  But as long as you and the surgeon understand the risks involved, there is no reason not to operate if you have a significant cataract.

P:  Does vision return after a cataract is removed?  

Dr. Elliot Werner:  Usually, yes.  As long as the retina and optic nerve are relatively intact.

P:  If a cataract is removed before a trab, can another cataract form afterwards as a result of the surgery?

Dr. Elliot Werner:  No.  Once the lens of the eye is removed, it does not grow back.

P:  If a patient has a cataract and is also a candidate soon for a trabeculectomy, would you remove the cataract before performing the trabeculectomy?  

Dr. Elliot Werner:  That would depend upon how bad the glaucoma is, how bad the cataract is, what the response has been to medical treatment.  In many situations, we would remove the cataract and do the trab at the same time. 

P:  How long after a trabeculectomy is it "safe" to remove the cataract?  And does cataract surgery increase the pressure?

Dr. Elliot Werner:  I usually wait at least six months.  There is some risk that the filter may fail after cataract surgery, although usually it doesn't.

P:  How soon after glaucoma surgery would you normally see a cataract develop?

Dr. Elliot Werner:  That varies a lot, but usually anywhere between three months and five years.  

P:  I have a scleral buckle on the eye not being operated on.  Would you operate on such an eye?  Do you usually operate on just one eye? 

Dr. Elliot Werner:  A scleral buckle does not usually prevent doing a glaucoma operation, but the previous surgery and retinal detachment increase the risk of failure and complications.  Generally, glaucoma operations are performed on one eye at a time, although in desperate cases, we may operate on the two eyes a few days apart. 

P:  Would you be against using memantine post-op?

Dr. Elliot Werner:  I don't know why memantine would be used.  It is an experimental drug that has not yet been shown to be of any benefit in glaucoma.

P:  I have high blood pressure.  Should I check with my general physician to inquire if the medication is giving me high eye pressure before having the laser surgery?  

Dr. Elliot Werner:  That's not necessary.  ALT is a very safe and easy procedure.  You won't feel anything.  It is not much more stressful than simply being examined.  In fact, it takes less time than a complete eye exam.

P:  Is there an IOP (intraocular pressure) so high that glaucoma surgery should not be performed until the IOP is lowered?  

Dr. Elliot Werner:  Glaucoma surgery is done to lower IOP that is too high, so the pre-op IOP level really doesn't matter.   The surgeon may do things a little differently during the operation in the presence of very high IOP, but there is no reason to delay because the IOP is very high.

P:  Is it harmful to use the computer after trab surgery? I start feeling dizzy after a few minutes of use.  

Dr. Elliot Werner:  No.  Using a computer will not cause any harm.  

P:  Does having a past eye infection, such as shingles (herpes zoster) add risk to any eye surgery?

Dr. Elliot Werner:  That depends on the type of infection.  A previous episode of a simple conjunctivitis probably is no added risk.  A history of corneal ulcers, herpes simplex, herpes zoster, or HIV- related infections is a real problem.  

P:  I had an allergic reaction to the eye drops prescribed by my doctor and had to stop using them.  Can ALT be performed if  drops were not used? 

Dr. Elliot Werner:  Yes, ALT can be done whether or not drops are being used or have ever been used.  

P:  If a pigment test showed that ALT would not work, would that also hold true for SLT?

Dr. Elliot Werner:  I have never heard of a "pigment test" to tell in advance if an ALT will work.  ALT has a lower success rate in eyes with very little trabecular meshwork pigment, but they still often work.  SLT has not been around long enough to know what the results are.

End of highlights for April 24, 2002.

On May 1, Dr. Wilson discussed "Low Vision Aids" in the Chat room. Click here for highlights of that meeting.

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