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Abstract #19199 Published in IGR 3-1
Between a rock and a soft place
Van Buskirk EMJournal of Glaucoma 2001; 10: 75-76
This editorial deals with the Charybdal-Scyllan dilemma of the eye becoming too soft or too hard after filtration surgery. In the early days of surgery, both the surgeon and the patient expected to face a period of time, usually a few days to a week or two, of blurred vision and hypotony, sometimes associated with shallow anterior chamber and associated complications. In those days, public confidence in physicians was at an all-time high and patients were willing to accept some discomfort if only their disease could be helped. Later on, patient expectations changed considerably and less inconvenience was accepted. The marketed portrayals of out-patient cataract surgery trivialized the complexity and vagaries of glaucoma management. In the 1970s, guarded filtration improved postoperative complications but often provided higher long-term intraocular pressure. More than a few surgeons convinced themselves that they could visually or manumetrically titrate fistula flow at the time of surgery in order to achieve ideal postoperative pressure. Good data on filtration surgery and its management are difficult to come by. The editor briefly discusses a report in that issue of the Journal of Glaucoma which suggests that all the commotion about early postoperative low pressures is at best unnecessary and at worst actually harmful. Most patients sustain no visual impairment. Anti-metabolites seem to restore better pressures, but with their known problems. According to the editor, not even suture manipulation was the solution. He pleads for a better understanding of how the eye does return to normal pressure, in order to find a better basis from which to plan the definite intervention. In the meantime, surgeons must learn to curb their own insecurity, aggressiveness, and disquietude over uncertainty, if they are to provide the best, most circumscribed care for their patients. It is an uncertain operation for an uncertain disease.
Classification:
12.8.11 Complications, endophthalmitis (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
