Treatment2

Primarily, the underlying cause of the IOP elevation must be resolved; this is detailed below. In addition, topical agents (beta blockers, prostaglandin analogs3, carbonic anhydrase inhibitors, and, occasionally, alpha agonists) are used, occasionally supported by oral carbonic anhydrase inhibitors.

If the IOP remains elevated despite maximal medical treatment, laser (argon laser iridectomy and trabeculoplasty, YAG trabeculopuncture, diode laser cyclodestruction [2, 3, 15, 17, 18, 22, 26, 28, 41]), cyclocryopexy [24], and surgery (iridectomy, trabeculectomy with or without antimetabolites [20, 30, 36], shunt implantation [31]) are the next weapons in the ophthalmologist's armamentarium. The most commonly used antimetabolites are mitomycin-C (0.2-0.4 mg/ml) and 5-FU 5-fluorouracil (50 mg/ml) [38]. Eyes that have undergone a filtering procedure are at a higher risk of endophthalmitis (Fig. 2.18.1): if an antimetabolite has been used, the annual incidence reaches 1.3% [9]. For eyes with intractable glaucoma, retinectomy remains a viable therapeutic option [16].

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