Post-Scleral Buckling Surgery: Managing Acute Glaucoma Risks - Ophthalmology

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Post-scleral buckling surgery is a common procedure performed to treat retinal detachment, and while it can be effective in reattaching the retina, it can also lead to complications such as elevated intraocular pressure (IOP) and acute glaucoma. Your situation, where you have experienced recurrent episodes of elevated eye pressure, is not uncommon among patients who have undergone this type of surgery.

The management of acute glaucoma risks following scleral buckling surgery involves a multifaceted approach. First and foremost, it is essential to monitor your intraocular pressure regularly, especially since you have a history of elevated IOP. The fact that your right eye has been problematic while your left eye remains stable suggests that the issue may indeed be related to the surgical intervention rather than a systemic problem.

In your case, the use of medications such as AZEL (which I assume refers to a topical carbonic anhydrase inhibitor) is a standard approach to manage elevated IOP. However, the persistent elevation of IOP despite medication indicates that there may be an underlying issue that needs to be addressed. The concern about the scleral buckle causing increased pressure is valid, as the buckle can sometimes lead to changes in the anatomy of the eye that may obstruct aqueous outflow, resulting in glaucoma.

If your ophthalmologist is considering the removal of the buckle, it is crucial to weigh the risks and benefits. The primary risk of removing the buckle is the potential for retinal detachment to recur. However, if the buckle is indeed contributing to your elevated IOP and the medications are not providing adequate control, removal may be necessary to prevent further complications, including the risk of vision loss due to uncontrolled glaucoma.

The decision to proceed with buckle removal should involve a thorough discussion with your ophthalmologist about the likelihood of retinal detachment recurrence, the potential for improved IOP control, and the overall health of your retina. It may also be beneficial to seek a second opinion from a retinal specialist who has experience with scleral buckling and glaucoma management.

In addition to surgical options, there are other treatments for glaucoma that may be considered. These include laser treatments such as selective laser trabeculoplasty (SLT) or argon laser trabeculoplasty (ALT), which can help improve aqueous outflow and lower IOP. These procedures are generally less invasive than surgery and may provide relief from elevated IOP without the risks associated with buckle removal.

Lifestyle modifications, as you have mentioned, are also important in managing your eye health. Avoiding activities that could strain your eyes, maintaining a healthy diet, and adhering to your medication regimen are all critical components of managing your condition.

In summary, managing acute glaucoma risks after scleral buckling surgery requires careful monitoring, medication management, and potentially surgical intervention. It is essential to have open communication with your healthcare provider to determine the best course of action tailored to your specific situation. Your concerns about long-term medication use and potential kidney issues are valid, and addressing the root cause of your elevated IOP is crucial for your overall health and well-being.