Post-Operative Care for Globe Rupture Repair

Complications and Management

The American Academy of Ophthalmology recommends monitoring for hypotony, wound leakage, and other complications after globe rupture repair, with immediate surgical revision required for persistent hypotony with choroidal detachments or anterior chamber flattening 1
Conjunctival erosion or dehiscence should be treated with topical antibiotics until surgical closure can be performed, as suggested by the American Academy of Ophthalmology 1, 2
Patients should be monitored for signs of endophthalmitis, such as increasing pain, redness, or discharge, and differentiated from normal post-operative inflammation, as recommended by the American Academy of Ophthalmology 2

The American Academy of Ophthalmology recommends scheduling follow-up visits within 24-48 hours (day 3 post-op) and instructing patients to seek immediate attention for warning signs such as sudden decrease in vision, severe pain, discharge from the eye, or wound leakage 1, 3

A quinolone preparation, such as moxifloxacin or levofloxacin, is recommended for its wide range of activity against Gram-positive and Gram-negative organisms, according to the British Journal of Dermatology guidelines 4
Topical steroids, such as prednisolone acetate 1% ophthalmic suspension, should be administered 4 times daily for the first 2 weeks post-surgery, and then tapered over a period of days to weeks depending on inflammation severity, as recommended by the American Academy of Ophthalmology and the Taiwan Society of Cataract and Refractive Surgeons 5, 3
Alternative steroid regimens, such as loteprednol 0.5%, may be beneficial for patients with glaucoma to minimize IOP elevation risk, and preservative-free formulations are recommended for patients with dry eye disease or severe hyperalgesia to minimize ocular surface irritation 6
Anesthetic and NSAID drops should be prescribed judiciously, as they may delay corneal epithelialization, and patients should be monitored closely for elevated intraocular pressure, a common complication of prolonged corticosteroid use 3, 5

Follow-up visits should be scheduled every few days until the epithelium is healed, typically within 5 days, with additional monitoring as needed to check for inflammation and steroid-related side effects, as recommended by the American Academy of Ophthalmology and the Taiwan Society of Cataract and Refractive Surgeons 3, 5
Patients should be evaluated for infection, dry eye occurrence, or ocular surface damage, and visual acuity and intraocular pressure should be assessed at regular intervals, with treatment initiated or modified as necessary, according to the Taiwan Society of Cataract and Refractive Surgeons 5
Management of post-operative dry eye disease should include preservative-free artificial tears, more frequent administration of dry eye disease therapy after surgery, and consideration of punctal plugs, topical autologous serum, or topical cyclosporine after the first month if dry eye disease persists, as recommended by the Taiwan Society of Cataract and Refractive Surgeons 5