Perioperative pharmacological management in patients with glaucoma

• Published in: Archivos de la Sociedad Española de Oftalmología Vol. 90; no. 6; pp. 274 - 284
• Main Authors: Rodríguez Uña, I, Martínez-de-la-Casa, J M, Pablo Júlvez, L, Martínez Compadre, J A, García Feijoo, J, Belda Sanchís, J I, Canut Jordana, M I, Hernández-Barahona Palma, J, Muñoz Negrete, F J, Urcelay Segura, J L
• Format: Journal Article
• Language: English; Estonian; Spanish
• Published: Spain 01-06-2015
• Subjects: Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibiotic Prophylaxis; Cataract - complications; Cataract Extraction; Clinical Protocols; Combined Modality Therapy; Contraindications; Drug Administration Schedule; Filtering Surgery; Glaucoma - complications; Glaucoma - drug therapy; Glaucoma - surgery; Humans; Miotics; Ocular Hypertension - drug therapy; Ocular Hypertension - etiology; Perioperative Care - methods; Postoperative Complications - drug therapy; Practice Guidelines as Topic; Preservatives, Pharmaceutical; Prostaglandins - therapeutic use; Glaucoma; Prostaglandines; Cataract; Corticosteroids; Prostaglandinas; Filtration surgery; Phacoemulsification; Catarata; Corticoides; Cirugía filtrante; Antiinflamatorios no esteroideos; Facoemulsificación; Non-steroidal anti-inflammatory drugs (NSAIDs)
• ISSN: 1989-7286
• DOI: 10.1016/j.oftal.2014.06.003

REVIEẂS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery.
In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery.
this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome.