Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Postoperative Flat Anterior Chamber Medication

  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Dec 18, 2014
 

Medication Summary

Topical steroids are used to reduce inflammation postoperatively. The following topical eye drops, used singularly or combined for elevated pressure, may be used: beta-blockers, alpha-2 adrenergic agonist, prostaglandins, carbonic anhydrase inhibitors (topical or systemic), miotics, and sympathomimetics. Topical cycloplegic agents may be used in a shallow chamber associated with choroidal detachment or cyclodialysis clefts. Topical antibiotics are indicated in the presence of wound leaks.

Next

Osmotic diuretics

Class Summary

These agents are used to reduce pressure elevations associated with pupillary block. Osmotic agents increase the osmolarity of the glomerular filtrate and induce diuresis. This, in turn, hinders the tubular reabsorption of water, causing sodium and chloride excretion to increase.

Mannitol (Osmitrol, Resectisol)

 

For acute elevations, has a rapid onset. Reduces elevated IOP when the pressure cannot be lowered by other means.

Initially assess for adequate renal function in adults by administering a test dose of 200 mg/kg, given IV over 3-5 min. Should produce a urine flow of at least 30-50 mL/h of urine over 2-3 h.

In children, assess for adequate renal function by administering a test dose of 200 mg/kg, given IV over 3-5 min. Should produce a urine flow of at least 1 mL/kg over 1-3 h.

Previous
Next

Carbonic anhydrase inhibitors

Class Summary

These agents reduce vitreous volume and control intraocular pressure (IOP).

Acetazolamide sodium (Diamox, Diamox sequels)

 

Inhibits enzyme carbonic anhydrase, reducing rate of aqueous humor formation, which, in turn, reduces IOP. Used for adjunctive treatment of chronic simple (open-angle) glaucoma and secondary glaucoma and preoperatively in acute angle-closure glaucoma when delay of surgery desired to lower IOP.

Previous
Next

Beta-blockers

Class Summary

The exact mechanism of ocular antihypertensive action is not established, but it appears to be a reduction of aqueous humor production. However, some studies show a slight increase in outflow facility with timolol and metipranolol.

Timolol maleate (Timoptic, Timoptic XE, Blocadren)

 

May reduce elevated and normal IOP, with or without glaucoma by reducing production of aqueous humor or by outflow. Available as 0.25% and 0.50% in aqueous and in gel for long action.

Previous
Next

Cycloplegics and mydriatics

Class Summary

These agents are used to overcome pupillary block. Instillation of a long-acting cycloplegic agent can relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.

Atropine ophthalmic (Isopto Atropine, Atropisol)

 

Acts at parasympathetic sites in smooth muscle to block response of sphincter muscle of iris and muscle of ciliary body to acetylcholine, causing mydriasis and cycloplegia. Available as 0.5% and 1% ointment and solution.

Previous
 
 
Contributor Information and Disclosures
Author

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

James V Aquavella, MD Professor of Ophthalmology, Department of Ophthalmology, University of Rochester School of Medicine, University of Rochester Eye Institute

James V Aquavella, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Medical Association, Contact Lens Association of Ophthalmologists, and International College of Surgeons

Disclosure: Nothing to disclose. R Marshall Ford, MD Cornea Fellowship, Flaum Eye Institute at University of Rochester School of Medicine and Dentistry

R Marshall Ford, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Gregory J McCormick, MD Consulting Staff, Corneal and Refractive Surgery, Vermont Laser Vision at Timber Lane and Ophthalmic Consultants of Vermont

Gregory J McCormick, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, International Society of Refractive Surgery, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

References
  1. [Guideline] Glaucoma Panel, Preferred Practice Patterns Committee. Primary open-angle glaucoma. San Francisco (CA): American Academy of Ophthalmology (AAO); 2005.

  2. de Barros DS, Navarro JB, Mantravadi AV, et al. The early flat anterior chamber after trabeculectomy: a randomized, prospective study of 3 methods of management. J Glaucoma. 2009 Jan. 18(1):13-20. [Medline].

  3. Ono T, Yuki K, Shiba D, Abe T, Kouyama K, Tsubota K. Postoperative flat anterior chamber: incidence, risk factors, and effect on the long-term success of trabeculectomy. Jpn J Ophthalmol. 2013 Nov. 57(6):520-8. [Medline].

  4. Hosoda S, Yuki K, Ono T, Tsubota K. Ophthalmic viscoelastic device injection for the treatment of flat anterior chamber after trabeculectomy: a case series study. Clin Ophthalmol. 2013. 7:1781-5. [Medline]. [Full Text].

  5. Popovic V. Early choroidal detachment after trabeculectomy. Acta Ophthalmol Scand. 1998 Jun. 76(3):367-71. [Medline].

  6. Arevalo JF, Garcia RA, Fernandez CF. Anterior segment inflammation and hypotony after posterior segment surgery. Ophthalmol Clin North Am. 2004 Dec. 17(4):527-37, vi. [Medline].

  7. Azuara-Blanco A, Dua HS. Malignant glaucoma after diode laser cyclophotocoagulation. Am J Ophthalmol. 1999 Apr. 127(4):467-9. [Medline].

  8. Beigi B, O'Keefe M, Algawi K, Acheson R, Burke J. Sulphur hexafluoride in the treatment of flat anterior chamber following trabeculectomy. Eye. 1997. 11 (Pt 5):672-6. [Medline].

  9. Chisalita D, Poiata I, Cozma D. [Postoperative flat anterior chamber. The therapeutic approach]. Oftalmologia. 1997. 41(3):251-6. [Medline].

  10. Dugel PU, Heuer DK, Thach AB, Baerveldt G, Lee PP, Lloyd MA, et al. Annular peripheral choroidal detachment simulating aqueous misdirection after glaucoma surgery. Ophthalmology. 1997 Mar. 104(3):439-44. [Medline].

  11. Greenfield DS, Liebmann JM, Jee J, Ritch R. Late-onset bleb leaks after glaucoma filtering surgery. Arch Ophthalmol. 1998 Apr. 116(4):443-7. [Medline].

  12. Hatton MP, Perez VL, Dohlman CH. Corneal oedema in ocular hypotony. Exp Eye Res. 2004 Mar. 78(3):549-52. [Medline].

  13. Lee SJ, Lee CK, Kim WS. Long-term therapeutic efficacy of phacoemulsification with intraocular lens implantation in patients with phacomorphic glaucoma. J Cataract Refract Surg. 2010 May. 36(5):783-9. [Medline].

  14. O'Sullivan F, Dalton R, Rostron CK. Fibrin glue: an alternative method of wound closure in glaucoma surgery. J Glaucoma. 1996 Dec. 5(6):367-70. [Medline].

  15. Osher RH, Cionni RJ, Cohen JS. Re-forming the flat anterior chamber with Healon. J Cataract Refract Surg. 1996 May. 22(4):411-5. [Medline].

  16. Ritch R. Chronic angle-closure glaucoma. Glaucoma. 1999. 189-194.

  17. Shahid H, Salmon JF. Malignant glaucoma: a review of the modern literature. J Ophthalmol. 2012. 2012:852659. [Medline]. [Full Text].

  18. Starita RJ, Klapper RM. Neodymium:YAG photodisruption of the anterior hyaloid face in aphakic flat chamber: a diagnostic and therapeutic tool. Int Ophthalmol Clin. 1985. 25(3):119-23. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.