From the Guidelines
Hypercalcemia following iridectomy is usually transient and managed with monitoring, as it often resolves on its own due to inflammation. The primary goal is to identify and treat any underlying causes of hypercalcemia, such as altered aqueous humor dynamics, medication effects, or unmasking of pre-existing hyperparathyroidism 1.
Initial Management
Initial management includes:
- Monitoring serum calcium levels
- Assessing renal function and electrolytes
- Evaluating the patient for any signs of hypercalcemia-related complications
Treatment
Treatment is usually not necessary, as hypercalcemia is often transient. However, if symptoms persist or are severe, treatment may include:
- Aggressive intravenous fluid rehydration with normal saline to increase renal calcium excretion
- Bisphosphonates, such as zoledronic acid or pamidronate, for moderate to severe hypercalcemia
- Calcitonin for rapid, short-term calcium reduction
- Loop diuretics, like furosemide, to enhance calcium excretion after adequate hydration
- Glucocorticoids, such as prednisone, if hypercalcemia is related to increased vitamin D activity
Follow-up
Regular follow-up evaluations should include:
- Confirming the patency of the iridotomy
- Measuring intraocular pressure (IOP)
- Performing dark-room gonioscopy with compression/indentation to assess the extent of peripheral anterior synechiae (PAS)
- Examining the fundus as clinically indicated 1
Underlying Cause Investigation
Investigating the underlying cause of hypercalcemia is crucial, as it may result from:
- Altered aqueous humor dynamics affecting calcium homeostasis
- Medication effects
- Unmasking of pre-existing hyperparathyroidism
By prioritizing the investigation of the underlying cause and providing supportive care, the management of hypercalcemia following iridectomy can be optimized, reducing the risk of complications and improving patient outcomes 1.
From the Research
Management of Hypercalcemia
The management of hypercalcemia following iridectomy is crucial to prevent further complications.
- Hypercalcemia after iridectomy is usually transient due to inflammation, but in some cases, it may be caused by other underlying conditions such as hyperparathyroidism or malignancy 2.
- Treatment of hypercalcemia typically involves adequate hydration, intravenous bisphosphonates, and occasionally calcitonin as a temporizing measure 3, 2.
- In cases of hypercalcemia caused by vitamin D intoxication, treatment with glucocorticoids and bisphosphonates may be warranted 4.
- The underlying cause of hypercalcemia should be treated, such as employing chemotherapy for malignancy or parathyroidectomy for hyperparathyroidism 2, 5.
Treatment Options
- Fluid volume repletion and forced diuresis are cornerstones in the therapy of acute hypercalcemia, regardless of its etiology 6.
- Medications including bisphosphonates, calcitonin, gallium nitrate, and glucocorticoids can be applied to treat hypercalcemia 3, 4, 6.
- In patients with advanced underlying kidney disease and refractory severe hypercalcemia, hemodialysis should be considered 5.
- Hematology or oncology and palliative care specialists should be involved early to guide the options of cancer-targeted therapies and help patients and their families with discussions of comfort-oriented care 5.