Post-Goniotomy Use of Pilocarpine Drops May Decrease Long-Term Glaucoma Treatment Requirements

A recent study has revealed that administering pilocarpine eye drops following Kahook Dual Blade (KDB) goniotomy surgery could enhance clinical outcomes for glaucoma patients while also potentially reducing their long-term medication needs. This research was conducted by experts in the Department of Ophthalmology at the University of Colorado School of Medicine and published in the journal Current Eye Research.

The KDB goniotomy is a minimally invasive surgical procedure frequently performed at the Sue Anschutz-Rodgers Eye Center. There has been inconsistency in post-operative eye drop regimens among different healthcare providers, as some prescribe pilocarpine drops while others do not. This prompted the researchers to investigate whether these drops could significantly impact patient outcomes following surgery.

The study analyzed data from 532 KDB goniotomy procedures performed between September 2015 and March 2020, comparing outcomes between patients who received pilocarpine drops and those who did not. Surgical success was defined as achieving an intraocular pressure (IOP) of less than 21 mmHg, alongside either a reduction in IOP of more than 20% or a decrease in the number of topical glaucoma medications used.

Results indicated that patients who received pilocarpine drops experienced a markedly higher success rate at one month, three months, and one year post-surgery, alongside a reduced requirement for glaucoma medications compared to those who did not use the drops.

Glaucoma is a progressive eye condition that affects over 4.2 million adults in the United States, characterized by damage to the optic nerve due to fluid buildup in the eye. While there is no cure for glaucoma, treatment typically involves medications and surgical interventions aimed at lowering IOP. Goniotomy is designed to enhance the eye's drainage system, facilitating fluid outflow and consequently alleviating pressure.

In this context, the KDB method, developed over a decade ago, focuses on opening the trabecular meshwork, thereby improving drainage. Pilocarpine has traditionally been utilized to reduce IOP, and it also modifies pupil size and increases tension in specific drainage pathways, which may help maintain patency after surgical healing.

Participants in the study who utilized pilocarpine typically continued the drops for about one month following their surgery, after which they generally required fewer medications to manage their glaucoma effectively.

The findings from this research provide valuable insights for ophthalmologists performing KDB goniotomy, as they suggest that pilocarpine could be an effective adjunct to surgical treatment. This evidence may assist surgeons in making informed decisions about postoperative care for their patients.

However, it is essential to consider that pilocarpine drops may present side effects such as headaches, blurred vision, and an increased risk of retinal detachment, as well as temporary discomfort in the eye. Some patients may not be suitable candidates for these drops, but the study's results have encouraged practitioners to reconsider the use of pilocarpine in their treatment plans.

Overall, the ability to potentially decrease the long-term need for glaucoma medications through the short-term use of pilocarpine drops is a promising prospect for enhancing patient care and improving adherence to treatment.