Dr. David J. Mathew
Ophthalmology (Eye Care)
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Patient's Query
Hi doctor,
Nine years ago, I have had phacoemulsification and IOL implant on my left eye. Post surgery, I developed acute steroid induced ocular hypertension, which was resolved with IV drug treatment. Fast forward, I developed open angle glaucoma in both eyes and I am undergoing trabeculectomy for the right eye (non-phaco LASIK eye) and will undergo phaco in the trabeculectomy eye as well since there is a sign of a posterior subcapsular cataract. I am already on maximum medical therapy Xalatan, Cosopt, Alphagan-P and Diamox. The visual acuity is already bad on the right eye due to glaucoma; it is about 78% according to a recent visual field test. So, I am not too worried about that. I have been placed on Xalatan for almost half a year now on my left eye, which had phaco done. Vision is still good, but there appears to be a slight haze and the glare appears to worsen over the past few months after starting Xalatan. The IOP is now controlled to around 16 mmHg and with Diamox it has on occasion even lowered to 10 mmHg. Is it normal to develop posterior capsular opacification 9 years post phacoemulsification? I was told that there were some mild PCO before I started Xalatan, but is it possible that the introduction of Xalatan hastened its progression even faster? With glaucoma under control, would a PCO laser capsulotomy be any risk for me? I mean would this still be recommended or would I be better hold off the surgery?
Hi,
Welcome to icliniq.com.
Thank you for the detailed description of your diagnosis.
From what you have described, you had undergone LASIK in the right eye, which has an uncontrolled intraocular pressure (IOP) on medical treatment. For this you plan for a combined trabeculectomy and cataract surgery (for the posterior subcapsular cataract). Your left eye has posterior capsule opacification (PCO) for which you have been advised to undergo laser capsulotomy. Developing PCO after around 9 years of a cataract surgery is not rare. It is an expected long-term complication, which can be effectively solved with a laser capsulotomy. There is no compelling evidence at present linking Xalatan (Latanoprost) to PCO. So, it is likely that the PCO just progressed over time. Following the laser capsulotomy, you may have an IOP spike. This will be controlled with the Xalatan and Diamox (Acetazolamide) that you are on. Your treating ophthalmologist may give you another IOP lowering medication before the procedure if needed. I would recommend that you go ahead with the laser capsulotomy as it is a very safe procedure. Also, an IOP of 34 in your right eye is not healthy. It is better to undergo the proposed combined procedure at the earliest.
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Ophthalmology (Eye Care)
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