Intraocular Pressure Spikes After Ophthalmic Laser Leading to Wipe-Out in Only-Eyed Patients: A Serious Complication Not to Be Overlooked

Intraocular pressure (IOP) spike following various ophthalmic laser procedures, such as laser peripheral iridotomy (LPI), Nd:YAG capsulotomy and laser trabeculoplasty, is a known risk of these procedures. Most cases are mild, amenable to medical treatment, with no impact on final vision. We present five only-eyed cases of wipe-out secondary to elevated IOP following ophthalmic laser procedures and their outcomes. Four out of five cases were associated with a poor visual outcome. Such cases should not be overlooked. In certain places like the UK, only post-LPI IOP is measured, but not other ophthalmic lasers, nor is pre- and post-procedure brimonodine or apraclonidine routinely prescribed to mitigate the IOP spike. We advocate the importance of post-procedure IOP checking, especially in advanced glaucoma patients with narrow safety margins. Precautions and assessment within the first hour post-procedure are critical for patients with very advanced or end-stage glaucoma and narrow safety margins, as urgent treatment may potentially reverse the adverse outcome for these patients.