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Effect of Eyelid Specula on Intraocular Pressure in Cataract Surgery

Effect of Eyelid Specula on Intraocular Pressure in Cataract Surgery. Gustave N. Alberti, M.D. 1 , Martha Schatz, M.D 2 . The authors have no financial interests in the material presented The materials presented here do not represent the views of the USAF.

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Effect of Eyelid Specula on Intraocular Pressure in Cataract Surgery

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  1. Effect of Eyelid Specula on Intraocular Pressure in Cataract Surgery Gustave N. Alberti, M.D.1, Martha Schatz, M.D2. The authors have no financial interests in the material presented The materials presented here do not represent the views of the USAF 1 – San Antonio Military Medical Center/Combined Warfighter Refractive Surgery Center, San Antonio, TX 2- University of Texas Health Sciences Center, San Antonio, TX

  2. Purpose • To evaluate whether eyelid specula commonly used in cataract surgery lead to changes in intraocular pressure (IOP). • There are many aspects of cataract surgery that lead to intraocular pressure elevation, including supine positioning, the use of viscoelastics, and hydrostatic forces during phacoemulsification. • One study in a pediatric population looking at 77 eyes of 45 children showed a 4mmHg elevation in IOP after the Alfonso newborn eyelid speculum placement. • However there is no data looking at speculum use during cataract surgery and their effect on IOP in adults. This knowledge could help guide speculum choice in the future for high-risk patients during ophthalmic surgery.

  3. Methods • 38 patients undergoing routine cataract surgery under topical anesthesia were recruited for this prospective unmasked study. • IOP measurements were performed before and after eyelid speculum placement with a Tono-Pen Avia. The first measurement took place once the patient had been lying on the surgical table for approximately 10 minutes, received a light benzodiazepine for comfort, and was ready to commence prepping in preparation for cataract surgery. The second measurement was performed approximately 5 minutes later, after the patient had been prepped and draped and the eyelid speculum had been inserted. • 10 measurements were made and only measurements displayed with a 95% confidence were recorded. The three lid specula utilized included the Lieberman (31), Seibel 3D (6), and Kratz-Barraquer (1).

  4. Results IOP pre- and post-speculum placement

  5. Results • The mean IOP prior to speculum placement in the OR was 25 mmHg (SD 6.59) • Mean IOP post speculum placement was 21.5 mmHg (SD 6.34) • The difference of 3.5 mmHg was found to be statistically significant at an alpha of 0.001 using a paired student t-test. • Average clinic IOP for these patients was 16.1 mmHg.

  6. Conclusion • Eyelid speculum placement does not seem to lead to increases in intraocular pressure during routine cataract surgery, IOP was actually lower after speculum placement. • Interestingly, supine positioning and autoregulatory mechanisms seemed to have the greatest effect on IOP changes. Three of the patients had IOP above 40 in the OR despite having IOP of 18, 19, and 22 in clinic, and no history of glaucoma. There was a 9mmHg difference between supine positioning in the OR and preoperative clinic IOP. • While there are many factors leading to an increase in IOP during cataract surgery, speculum use does not appear to be one of them. • Supine IOP measurements may prove useful in evaluating glaucoma suspects with normal clinic IOP

  7. References • 1. Epley, K. David; Tychsen, Lawrence; Lueder, Gregg T. The effect of an eyelid speculum on intraocular pressure measurement in children.American Journal of Ophthalmology. 134(6). December 2002. 926-927. • 2. Tranos, P., Bhar, G., Little, B. Postoperative intraocular pressure spikes: the need to treat. Eye (2004), 18, 673-679. • 3. Buono LM, Foroozan R, Sergott RC, Savino PJ. Nonarteritic anterior ischemic optic neuropathy. Curr Opin Ophthalmol 2002; 13(6): 357-361. • 4. Basile C, Addabbo G, Montanaro A. Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia. J Nephrol 2001; 14(5):420-423. • 5. Kolker AE. Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc 1977; 75: 539-555. • 6. Rich, WJ. Effect of lid specula and superior rectus traction on intraocular pressure. Trans Ophthalmol Soc UK. 1977 Apr; 97(1):106-8. • 7. Dollery CT, Helkind P, Kohner EM, Paterson JW. Effect of raised intraocular pressure on the retinal and choroidal circulation. Invest Ophthalmol 1968; 7: 191-197. • 8. Geijer C, Bill A. Effect of raised intraocular pressure on retinal, prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys. Invest Ophthalmol Vis Sci 1979; 18: 1030-1042. • 9. Johnson EC, Deppmeier LMH, Wentzien SKF, Hsu I, Morrison JC. Chronology of optic nerve and retinal responses to elevated intraocular pressure. Invest Ophthalmol Vis Sci. 2000; 41: 431-442. • 10. Takahiro Kiuchi, Yuta Motoyama, Tetsuro Oshika. Relationship of Progression of Visual Field Damage to Postural Changes in Intraocular Pressure in Patients with Normal-Tension Glaucoma. Ophthalmology 2006;113:2150 –2155 • 11. Tsukahara, S., Sasaki, T. Postural change of IOP in normal persons and in patients with primary wide open-angle glaucoma and low-tension glaucoma. British Journal of Ophthalmology, 1984, 68, 389-392

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