Refractive surgery in glaucoma and suspected glaucoma patients: Critical analysis of the literature and clinical recommendations

Figueiredo, Sarah Mariz Veras Pinto; Ricardo, Olívia Moura de Paula; Barbosa, Wilma Lelis; Prata, Tiago Santos

doi:10.5935/0004-2749.2024-0351

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Refractive surgery in glaucoma and suspected glaucoma patients: Critical analysis of the literature and clinical recommendations

Sarah Mariz Veras Pinto Figueiredo¹; Olívia Moura de Paula Ricardo²; Wilma Lelis Barbosa³; Tiago Santos Prata^1,2,4

DOI: 10.5935/0004-2749.2024-0351

ABSTRACT

Myopia is a significant risk factor for glaucoma and a growing public health problem worldwide. Detecting glaucomatous changes in highly myopic eyes is diagnostically challenging due to the abnormal appearance of the optic nerve head. These patients also have a greater biomechanical susceptibility to pressure-induced glaucomatous damage. Refractive surgery has become increasingly popular, and many candidates for refractive surgery are myopic. Therefore, we sought to review the aspects of patient evaluation in those who have undergone refractive surgery for myopia concerned with the detection and monitoring of glaucoma development. We identified several important elements of patient evaluation for glaucoma after refractive surgery. These included the need for both structural and functional assessments before and after surgery, and the importance of monitoring for postoperative biomechanical changes in the cornea and their impact on intraocular pressure. We conclude that, in patients who undergo refractive surgery for myopia, it is essential to assess for the presence of glaucoma, to identify staging, and to plan for long-term control of the disease, regardless of IOP.

Keywords: Glaucoma; Intraocular pressure; Myopia; Refractive surgery

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