* Mydriatics and cycloplegics. While certainly not a systemic medication, it is worth noting that topical tropicamide may cause increased IOP via mechanisms other than angle closure. After examining IOP fluctuations in children given mydriatics, researchers found an average increase of 2mm Hg; however, a potential increase or decrease of 8mm Hg was documented in many patients with open angles. 27 The investigators concluded that some alteration in aqueous dynamics occurred upon dilation and, because of the variable effect on IOP (even without the presence of anterior segment complications), all patients who use mydriatics require observation. 27
The FDA approval of the Trabectome (NeoMedix) in 2006 introduced the first procedure for microinvasive glaucoma surgery (MIGS), ab interno trabecular ablation. The surgeon uses microelectrocautery to ablate the trabecular meshwork and inner wall of Schlemm canal. Trabectome surgery may be performed independently or in conjunction with other intraocular procedures such as cataract extraction/IOL placement (see Watch It Now ). It may be performed on pediatric, adult, pseudophakic, and phakic patients and is an option for treating the spectrum of glaucoma severity (ocular hypertension to end-stage disease).
Long term use of topical & systemic steroids produce secondary open angle glaucoma similar to chronic simple glaucoma. The increased IOP caused by prolonged steroid therapy is reversible but the damage produced by it is irreversible. In this study, we analysed 25 patients (44 eyes) with steroid induced glaucoma, who reported to us with dimness of vision, haloes and elevated . and were using steroids for long duration due to various causes. The behaviour of the . due to different steroid preparations, the type of lenticular change, and the management of those cases are discussed in this paper. From our study we conclude that dexamethasone and betamethasone both topical as well as systemic are more potent in producing glaucoma and cataract than medrysone and prednisolone. The condition is reversible without permanent damage when the duration of steroid therapy is short and vice versa.