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Riley Hall BSc α , Robert Mitchell MD, FRCSC β

Comparison of postoperative intraocular pressures after phacoemulsification with and without use if anti glaucoma drops. Riley Hall BSc α , Robert Mitchell MD, FRCSC β University of Saskatchewan α , University of Calgary β. Authors have no financial interest. OBJECTIVES.

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Riley Hall BSc α , Robert Mitchell MD, FRCSC β

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  1. Comparison of postoperative intraocular pressures after phacoemulsification with and without use if anti glaucoma drops Riley Hall BScα, Robert Mitchell MD, FRCSCβ University of Saskatchewanα, University of Calgaryβ Authors have no financial interest

  2. OBJECTIVES To determine the intraocular pressure in the immediate 4 hour period following cataract surgery and establish whether the use of anti-glaucoma drops applied at the end of surgery influences it.

  3. METHODS A double blind study was performed at an ambulatory surgical center in Calgary, Alberta, Canada. Prospective data was collected from patients scheduled for routine, microincisional cataract surgery (MICS). All surgeries were uncomplicated. A soft, foldable intraocular lens was inserted into the posterior chamber. Ocucoat viscoelastic (methacellulose) was carefully washed out at the end of each procedure. Intraocular pressures were set at 20-30 mmHg using a Barraquer tonometer at the end of each case. After receiving prior informed consent, patients were randomly selected into two groups. One group received a combination beta-blocker and carbonic anhydrase inhibitor drop at the end of surgery. The other group received no anti-glaucoma therapy at the end of surgery. The Intraocular pressures in the two groups were measured prior to surgery, at 1 and 4 hours post operatively, and the following day using an iCare tonometer TA011. This instrument was selected as it is the least invasive and safest method to test pressure on newly operated eyes. The intraocular pressures in the 2 groups were then compared.

  4. RESULTS Intraocular pressures were analyzed in 80 eyes of 71 patients, 39 received the anti-glaucoma drop and 41 did not. The treated eyes had an average intraocular pressure at 1 hour of 13.95mmHg (SD=7.97mmHg, 4.12% decrease from preop). At 4 hours it was 15.09mmHg (SD=5.91mmHg, 3.58% increase from preop), and the following day it was 12.02mmHg (SD=4.96mmHg, 17.39% decrease from preop). The untreated eyes had an average intraocular pressure at 1 hour of 23.17mmHg (SD=10.11mmHg, 35.09% increase from preop). At 4 hours it was 25.33mmHg (SD=8.93mmHg, 40.62% increase from preop) and the following day it was 17.82mmHg (SD=4.41mmHg, 18.48% increase from preop). Patients with intraocular pressure greater than 35mmHg at any point during the study were treated but remained in the study. There were 8 such cases (7 from the untreated group; 1 from the treated group).

  5. Summary of intraocular pressures at 1 hour, 4 hours, and the following day.

  6. DISCUSSION Many patients experience an intraocular pressure spike following cataract surgery. Intraocular pressure can be greater than 30mm Hg when measured the same day as surgery.1 Kir, Lakmak, and Dyanir determined that 1 drop of brinzolamide (carbonic anhydrase inhibitor) 1% following clear corneal phacoemulsification surgery is sufficient to control intraocular pressure rise within the first 4 to 6 hours following surgery.2 In our study, 10 out of 80 (12.5%) operated eyes developed a complication following surgery requiring immediate treatment. These complications included 8 cases of intraocular pressure spikes greater than 35mmHg, a wound leak, and a corneal abrasion.

  7. CONCLUSIONS Based on the results of our study we believe that all patients would benefit from receiving an anti-glaucoma drop at the end of cataract surgery. This would eliminate the often significant spike in intraocular pressure that may occur in the 4 hour period following cataract surgery. Additionally, examination of the eye in the early postoperative period may reveal complications that would otherwise go unnoticed.

  8. REFERENCES Tranos, PG et al. Same-day versus first day review of intraocular pressure after uneventful phacoemulsification. J Cataract Refract Surg. 2003; 29:508-512 Kir, E, Lakmak, H, Dyanir, V. Medical control of intraocular pressure with brinzolamide 1% after phacoemulsification. Can J Ophthalmol. 2008; vol. 43 no. 5.

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