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Kanjee R, Popovic MM, Salimi A, Hutnik CML, Ahmed IIK, Saheb H. Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis. Eye (Lond) 2024; 38:1518-1528. [PMID: 38326483 PMCID: PMC11126686 DOI: 10.1038/s41433-024-02940-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification. METHODS Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs). CONCLUSION Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.
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Affiliation(s)
- Raageen Kanjee
- Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Ali Salimi
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada
| | | | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Hady Saheb
- Department of Ophthalmology & Visual Sciences, McGill University, Montreal, QC, Canada.
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Hayashi K, Yoshida M, Sato T, Manabe SI. Effect of Topical Hypotensive Medications for Preventing Intraocular Pressure Increase after Cataract Surgery in Eyes with Glaucoma. Am J Ophthalmol 2019; 205:91-98. [PMID: 30902694 DOI: 10.1016/j.ajo.2019.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare the effects of a topical intraocular pressure (IOP)-lowering medication for preventing an IOP increase after cataract surgery in eyes with glaucoma. DESIGN Randomized clinical study. METHODS A total of 165 eyes of 165 patients with primary open-angle glaucoma or pseudoexfoliation glaucoma scheduled for phacoemulsification were randomly assigned to 1 of 3 groups to receive each medication immediately postoperatively: 1) prostaglandin F2α analog (travoprost), 2) β-blocker (timolol maleate), or 3) carbonic anhydrase inhibitor (brinzolamide). Intraocular pressure (IOP) was measured using a rebound tonometer at 1 hour preoperatively, at the end of surgery, and at 2, 4, 6, 8, and 24 hours postoperatively. The incidence of eyes exhibiting a marked IOP increase to greater than 25 mm Hg was compared among the groups. RESULTS At 1 hour preoperatively and at the end of surgery, mean IOP did not differ significantly among the groups. Mean IOP increased significantly between 4 and 8 hours postoperatively and then decreased at 24 hours postoperatively in all groups (P < .0001). Mean IOP was significantly lower in the brinzolamide group than in the travoprost or timolol group at 4, 6, and 8 hours postoperatively (P ≤ .0374) and did not differ significantly among groups at 2 and 24 hours postoperatively. The incidence of an IOP spike was significantly lower in the brinzolamide group than in the travoprost and timolol groups (P = .0029). CONCLUSIONS Brinzolamide reduces the short-term IOP increase after cataract surgery more effectively than travoprost or timolol in eyes with glaucoma, suggesting that brinzolamide is preferable for preventing an IOP spike.
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Abstract
PURPOSE OF REVIEW The aim of this review was to assess the risk factors and course of postoperative intraocular pressure (IOP) increase in order to determine the optimal the treatment. RECENT FINDINGS Early postoperative IOP elevation following cataract surgery is a frequent adverse event, and might represent 88% early postoperative complications. The risk factors for IOP elevation following phacoemulsification cataract surgery include residual viscoelastic material, resident performed surgery, glaucoma, pseudoexfoliation syndrome, axial length over 25 mm, tamsulosin intake, topical steroid application in steroid responders. A day-1 postoperative follow-up might be questioned, even in glaucoma patients, as in IOP spikes the topmost IOP elevation occurs 3-4 h postoperatively. SUMMARY Several IOP-lowering agents have been evaluated, but none has completely prevented the occurrence of IOP spikes. We recommend applying a combination of dorzolamide/timolol and brinzolamide topically in high-risk patients, particularly with preexisting optic nerve damage. Corticosteroid cessation usually results in a reduction of the IOP to normal levels in steroid responders. Additional studies are required to assess the optimal treatment, especially in glaucoma patients.
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Grzybowski A, Kanclerz P. Do we need day-1 postoperative follow-up after cataract surgery? Graefes Arch Clin Exp Ophthalmol 2018; 257:855-861. [DOI: 10.1007/s00417-018-04210-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/21/2018] [Accepted: 12/04/2018] [Indexed: 12/18/2022] Open
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Georgakopoulos CD, Kagkelaris K, Pagoulatos D, Plotas P, Makri OE. Brinzolamide-brimonidine fixed combination for the prevention of intraocular pressure elevation after phacoemulsification. Eur J Ophthalmol 2018; 30:293-298. [PMID: 30526051 DOI: 10.1177/1120672118817997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the effectiveness of brinzolamide-brimonidine fixed combination to control the intraocular pressure elevation throughout the first 24 h following uncomplicated phacoemulsification cataract surgery. PATIENTS AND METHODS A total of 62 patients who underwent phacoemulsification cataract surgery were included in this prospective randomized comparative case series. The brinzolamide-brimonidine fixed combination group (34 eyes) was administered a single dose of brinzolamide-brimonidine fixed combination immediately after phacoemulsification. No treatment was administered in the control group (28 eyes). Intraocular pressure was measured 1 day before surgery (baseline) and at 6, 12 and 24 h postoperatively. RESULTS The brinzolamide-brimonidine fixed combination group had significantly lower intraocular pressure at 6, 12 and 24 h after phacoemulsification compared to baseline (p < 0.0001 for all comparisons), while in control group, intraocular pressure was significantly higher at 6 and 12 h after surgery compared to baseline (p < 0.001 and p < 0.0001, respectively). In control group, an intraocular pressure elevation ⩾ 5 mm Hg was noted in 32.4% of the eyes at 6 and 12 h and in 5.9% of eyes at 24 h after surgery, while in brinzolamide-brimonidine fixed combination group, only 8.8% of the eyes at 6 h postoperatively had such an intraocular pressure elevation. CONCLUSION The administration of a single drop of brinzolamide-brimonidine fixed combination effectively prevented intraocular pressure elevations and intraocular pressure spikes during the first 24 h after uneventful phacoemulsification.
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Affiliation(s)
| | | | - Dionysios Pagoulatos
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
| | - Panagiotis Plotas
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
| | - Olga E Makri
- Department of Ophthalmology, School of Medicine, University of Patras, Patras, Greece
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Intraocular Pressure Elevation after Vitrectomy for various Vitreoretinal Disorders. Eur J Ophthalmol 2018; 24:235-41. [DOI: 10.5301/ejo.5000350] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2013] [Indexed: 11/20/2022]
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Koçak-Altintas AG, Anayol MA, Cakmak HB, Simsek S. Effects of Topical Dorzolamide on IOP after Phacoemulsification with Different Types of Ophthalmic Viscosurgical Devices. Eur J Ophthalmol 2018; 17:38-44. [PMID: 17294381 DOI: 10.1177/112067210701700106] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of topical dorzolamide on postoperative intraocular pressure (IOP) after routine phacoemulsification surgery with different type of ophthalmic viscosurgical device (OVD). METHODS Patients who were scheduled for phacoemulsification with intraocular lens (IOL) implantation were evenly divided into four groups. Group I (83 eyes) received one drop of topical dorzolamide immediately after surgery and 1.4% NaHa (BD Visc) was used as a cohesive OVD during IOL implantation. Group II (83 eyes) did not receive any topical antiglaucoma medication after operation and 1.4% NaHa was used as a cohesive OVD. Group III (83 eyes) received topical dorzolamide and 1% NaHa (Healon) was used, and Group IV (83 eyes) did not receive any topical and 1% NaHa was used in operation. Mean postoperative IOPs were compared between groups. RESULTS Eyes with 1.4% NaHa usage (18.2+/-9.2 mmHg) had higher mean postoperative IOPs than eyes with 1% NaHa usage (15.5+/-5.3 mmHg) (p=0.002). Mean postoperative IOPs were lower in eyes with dorzolamide application (15.6+/-7.2 mmHg) than in eyes without any medication (18.1+/-8.5 mmHg) both in eyes with 1.4% NaHa and 1% NaHa usage (p=0.003). Dorzolamide application caused an average 2.5 mm decrease in mean postoperative IOPs in both groups. CONCLUSIONS Effects of OVDs on IOP rises after phacoemulsification surgery are closely related to their molecular structure. Increase in viscosity rendered higher postoperative IOP increments. However, topical dorzolamide application effectively reduced postoperative IOP increments in eyes with both Healon and BD Visc use.
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Affiliation(s)
- A G Koçak-Altintas
- Department of Ophthalmology, Ataturk Education and Research Hospital, Ankara, Turkey.
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Weiner Y, Severson ML, Weiner A. Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy. J Cataract Refract Surg 2016; 41:2081-91. [PMID: 26703283 DOI: 10.1016/j.jcrs.2015.10.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate intraocular pressure (IOP) immediately after cataract surgery with or without ab interno trabeculectomy (Trabectome) and whether trabeculectomy-related hyphema increases the risk for IOP spikes. SETTINGS Private glaucoma practice. DESIGN Retrospective interventional nonrandomized comparative chart review. METHODS Intraocular pressure was measured 3 to 4 hours and 20 hours postoperatively. RESULTS The combined group comprised 73 eyes of 73 patients and the cataract-only group, 75 eyes of 75 patients. The mean preoperative IOP was 15.8 mm Hg ± 3.6 (SD) and 14.9 ± 3.0 mm Hg, respectively (P = .09). In the combined group, the IOP decrease was significant at 3 to 4 hours (P = .0003) and 20 hours (P = .0007). In the cataract-only group, the IOP increased significantly (P < .0001 and P = .0035, respectively). The mean IOP was significantly lower in the combined group than in the cataract-only group at 3 to 4 hours (12.8 ± 5.9 mm Hg versus 19.7 ± 7.5 mm Hg) and 20 hours (12.7 ± 7.0 mm Hg versus 17.2 ± 5.9 mm Hg) (both P < .0001). Significantly fewer eyes in the combined group than in the cataract-only group had IOP spikes (overall, P = .0077; 3 to 4 hours, P = .001). Hyphema occurred in 35 eyes (47.9%) in the combined group; however, the IOP was similar with or without hyphema. Only 1 eye with an IOP spike in the combined group had hyphema. CONCLUSION Combining ab interno trabeculectomy and cataract surgery reduced short-term postoperative IOP and the incidence of IOP spikes despite the common hyphema. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Yotam Weiner
- From the Oakland University William Beaumont School of Medicine (Y. Weiner), Rochester Hills, Michigan, Hudson Valley Community College (Severson), Troy, New York, and Ophthalmic Consultants of the Capital Region (Severson, A. Weiner), Albany, New York, USA
| | - Melissa L Severson
- From the Oakland University William Beaumont School of Medicine (Y. Weiner), Rochester Hills, Michigan, Hudson Valley Community College (Severson), Troy, New York, and Ophthalmic Consultants of the Capital Region (Severson, A. Weiner), Albany, New York, USA
| | - Asher Weiner
- From the Oakland University William Beaumont School of Medicine (Y. Weiner), Rochester Hills, Michigan, Hudson Valley Community College (Severson), Troy, New York, and Ophthalmic Consultants of the Capital Region (Severson, A. Weiner), Albany, New York, USA.
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Gupta A, Vernon SA. Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension? Eye (Lond) 2015; 29:1299-307. [PMID: 25697456 DOI: 10.1038/eye.2014.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 12/07/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine whether the 1-day postoperative intraocular pressure (IOP) check following routine uncomplicated phacoemulsification is necessary in patients with pre-existing glaucoma and ocular hypertension (OHT), if acetazolamide prophylaxis is used. To investigate the practice of U.K. glaucoma specialists in IOP rise prophylaxis and follow-up regimes. PATIENTS AND METHODS The IOP 1-day postoperatively was analysed against the last recorded IOP before phacoemulsification in a cohort of patients with glaucoma or OHT who underwent uncomplicated phacoemulsification cataract surgery between December 2009 and September 2012, where it was routine practice to give acetazolamide postoperatively. U.K. and Eire Glaucoma Society members were surveyed via an online questionnaire to analyse practice among U.K. glaucoma specialists. RESULTS One hundred and seven eyes were studied: 99 with glaucoma and 8 with OHT. The mean IOP change was -0.8 mm Hg with only two eyes measuring >30 mm Hg postoperatively (2%). Both these eyes received 750 mg acetazolamide. Eighteen (17%) eyes had an IOP rise of at least 30%. In the survey of practice there were 65 respondents. Twenty-one (32%) respondents did not use IOP prophylaxis. Only 17 (26%) of respondents routinely reviewed their patients 1-day postoperatively. CONCLUSION Our prophylactic acetazolamide regime does not completely eliminate the risk of an IOP >30 mm Hg on day 1 post routine phacoemulsification in glaucoma/OHT patients. Patients with pre-existing glaucoma, despite acetazolamide prophylaxis, will require IOP management decisions on the first postoperative day after uncomplicated phacoemulsification surgery. U.K. expert practice is non-uniform with regard to IOP prophylaxis, and the 1-day review, and further discussion and formulation of consensus appears necessary.
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Affiliation(s)
- A Gupta
- Ophthalmology Department, Queen's Medical Centre, Nottingham, UK
| | - S A Vernon
- Ophthalmology Department, Queen's Medical Centre, Nottingham, UK
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Ornek K, Büyüktortop N, Ornek N, Oğurel R, Erbahçeci IE, Onaran Z. Effect of 1% brinzolamide and 0.5% timolol fixed combination on intraocular pressure after cataract surgery with phacoemulsification. Int J Ophthalmol 2013; 6:851-4. [PMID: 24392336 DOI: 10.3980/j.issn.2222-3959.2013.06.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/01/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the effect of brinzolamide-timolol fixed combination on intraocular pressure (IOP) after cataract surgery. METHODS The study included 92 eyes of 87 patients who underwent cataract surgery and intraocular lens implantation. Patients scheduled for phacoemulsification were assigned to 1 of 2 groups. The treatment group received 1 drop of brinzolamide-timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and at 2h and 24h postoperatively. RESULTS The mean IOP change was lower in the treatment group than in the control group at 2h postoperatively. The difference between the mean IOP values of the two groups at 2h postoperatively was found to be statistically significant. Twenty-four hours after the surgery, the mean IOP change was still higher in the control group when compared to the treatment group. CONCLUSION The fixed combination brinzolamide-timolol can effectively reduce IOP after cataract surgery.
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Affiliation(s)
- Kemal Ornek
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale 71100, Turkey
| | - Nesrin Büyüktortop
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale 71100, Turkey
| | - Nurgül Ornek
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale 71100, Turkey
| | - Reyhan Oğurel
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale 71100, Turkey
| | - Inci Elif Erbahçeci
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale 71100, Turkey
| | - Zafer Onaran
- Department of Ophthalmology, School of Medicine, Kırıkkale University, Kırıkkale 71100, Turkey
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Ulaş F, Balbaba M, Çelebi S. Effect of prophylactic intraocular pressure-lowering medication on pain during cataract surgery. J Ocul Pharmacol Ther 2013; 29:658-62. [PMID: 23461283 DOI: 10.1089/jop.2012.0244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study evaluated the effects of acetazolamide, latanoprost, travoprost, bimatoprost, brimonidine, brinzolamide, and timolol on pain during phacoemulsification cataract surgery. METHODS This prospective randomized comparative study included 323 eyes of 323 patients with no history of intraocular surgery or chronic eye disease who underwent uncomplicated phacoemulsification cataract surgery and foldable intraocular lens implantation under topical anesthesia. Patients were divided into 8 groups according to the preoperative prophylactic intraocular pressure (IOP)-lowering medication. The intraoperative pain was assessed postoperatively using a visual analog pain scale. The Kruskal-Wallis test investigated the differences in the visual analog pain-scale scores of the groups, and the Mann-Whitney U test investigated the pairwise comparison of the groups. RESULTS The median visual analog pain-scale score of the group that did not receive any IOP-lowering medication was 2.0±1.89. The brimonidine group exhibited the lowest visual analog pain-scale scores, and the prostanoids, especially the bimatoprost group, demonstrated the highest visual analog pain-scale scores (median±standard deviation were 0.0±1.50 and 2.0±1.91, respectively). The median visual analog pain-scale scores of the acetazolamide, latanoprost, travoprost, brinzolamide, and timolol groups were 0.0±1.62, 2.0±1.67, 2.0±1.73, 0.0±1.66, and 1.0±1.54, respectively. A pairwise comparison using the Mann-Whitney U test with Bonferroni correction revealed significant differences between the groups of acetozolamide and travoprost (p=0.001), acetozolamide and bimatoprost (p<0.001), travoprost and brimonidine (p<0.001), bimatoprost and brimonidine (p<0.001), and bimatoprost and timolol (p=0.001). CONCLUSIONS Prophylactic application of the IOP-lowering medication may alter the pain sensation during phacoemulsification cataract surgery.
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Affiliation(s)
- Fatih Ulaş
- Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
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Georgakopoulos CD, Makri OE, Plotas P, Pharmakakis N. Brinzolamide-timolol fixed combination for the prevention of intraocular pressure elevation after phacoemulsification. Clin Exp Ophthalmol 2013; 41:662-7. [PMID: 23432730 DOI: 10.1111/ceo.12092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 02/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the efficacy of brinzolamide-timolol fixed combination in intraocular pressure during the first 24 h after uneventful phacoemulsification cataract surgery using Viscoat and Provisc. DESIGN Prospective randomized comparative case series. PARTICIPANTS Ninety-two eyes of equal patients scheduled for phacoemulsification cataract surgery. METHODS Treatment group (52 eyes) received a drop of brinzolamide-timolol fixed combination immediately after surgery. Control group (40 eyes) received no treatment. MAIN OUTCOME MEASURES Intraocular pressure preoperatively and at 6, 12 and 24 h postoperatively. RESULTS Six hours after surgery the mean intraocular pressure decreased by 0.3 ± 2.95 mmHg (P > 0.05) in the treatment group and increased by 6.8 ± 2.78 mmHg (P < 0.001) in the control group. Twelve hours postoperatively, the mean intraocular pressure increased by 0.23 ± 3.49 mmHg (P > 0.05) in the treatment group and by 5.3 ± 3.26 mmHg (P < 0.001) in the control group. Twenty-four hours after surgery, the mean intraocular pressure decreased by 1.76 ± 2.83 mmHg (P < 0.01) in the treatment group and in the control group increased by 1.4 ± 2.46 mmHg (P > 0.05). The intraocular pressure in the treatment group was statistically significantly lower compared with the control group at 6, 12 and 24 h postoperatively. None of the eyes in the treatment group had postoperative intraocular pressure elevation ≥10 mmHg; such an increase was recorded in 20% and 10% of control eyes at 6 and 12 h after surgery, respectively. CONCLUSION A single dose of brinzolamide-timolol fixed combination after phacoemulsification cataract surgery prevented a significant intraocular pressure increase during the first 24 h postoperatively.
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Hasegawa Y, Okamoto F, Sugiura Y, Okamoto Y, Hiraoka T, Oshika T. Intraocular pressure elevation in the early postoperative period after vitrectomy for rhegmatogenous retinal detachment. Jpn J Ophthalmol 2011; 56:46-51. [DOI: 10.1007/s10384-011-0094-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
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Effect of a fixed brimonidine–timolol combination on intraocular pressure after phacoemulsification. J Cataract Refract Surg 2011; 37:279-83. [DOI: 10.1016/j.jcrs.2010.08.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 08/20/2010] [Accepted: 08/26/2010] [Indexed: 11/21/2022]
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Kandarakis A, Soumplis V, Karampelas M, Panos C, Kyriakos N, Baxevanakis A, Karagiannis D. Efficacy of brimonidine in preventing intraocular pressure spikes following phacoemulsification in glaucoma patients. Eur J Ophthalmol 2010; 20:994-9. [PMID: 20544673 DOI: 10.1177/112067211002000619] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To measure intraocular pressure (IOP) elevation 6 and 24 hours after phacoemulsification in patients with glaucoma and to investigate the efficacy of brimonidine tartrate 0.2% in preventing IOP rise on the first postoperative day following cataract surgery. METHODS In this prospective randomized single-masked study, 86 eyes of 78 patients with well-controlled open-angle glaucoma were scheduled for phacoemulsification surgery. Patients were randomly assigned into 2 groups. Group A received 1 drop of brimonidine tartrate 0.2% and group B, which served as a control group, received 1 drop of artificial tears. Intraocular pressure was measured at baseline, before surgery, and 6 and 24 hours postoperatively. RESULTS Within each group, we found a statistically significant difference in IOP between baseline and 6 hours postoperatively (p<0.01) and between 6 and 24 hours (p<0.01). There was no statistically significant difference between baseline IOP and 24-hour values. Comparing the 2 groups, there was no statistically significant difference in preoperative and 24-hour postoperative IOP. Six hours after surgery, the mean IOP in the brimonidine group was 18.52±4.58 mmHg, compared with 20.86±3.79 mmHg in the control group. Treatment with brimonidine tartrate 0.2% significantly reduced postoperative IOP elevation 6 hours following cataract extraction (p=0.009). CONCLUSIONS Patients with medically well-controlled glaucoma may experience a substantial increase in IOP shortly after phacoemulsification surgery. Instillation of brimonidine tartrate 0.2%, although it significantly reduced IOP elevation following cataract operation, did not completely prevent IOP spikes.
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Affiliation(s)
- Artemios Kandarakis
- 1st Ophthalmology Department, Ophthalmiatrion Eye Hospital of Athens, Sina 2, Athens, Greece.
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Levkovitch-Verbin H, Habot-Wilner Z, Burla N, Melamed S, Goldenfeld M, Bar-Sela SM, Sachs D. Intraocular Pressure Elevation within the First 24 Hours after Cataract Surgery in Patients with Glaucoma or Exfoliation Syndrome. Ophthalmology 2008; 115:104-8. [PMID: 17561259 DOI: 10.1016/j.ophtha.2007.03.058] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 03/21/2007] [Accepted: 03/21/2007] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To investigate whether eyes with glaucoma or exfoliation syndrome without glaucoma are prone to exhibit intraocular pressure (IOP) elevation shortly after cataract surgery and, if so, whether timolol maleate 0.5% reduces these spikes. DESIGN Prospective randomized double-masked clinical trial. PARTICIPANTS One hundred twenty-two patients with normal eyes, medically well-controlled glaucoma, or exfoliation syndrome who underwent uneventful phacoemulsification cataract extraction. METHODS Patients were randomly assigned to an immediately postoperative drop of either timolol maleate 0.5% or no treatment. Intraocular pressure was measured preoperatively and 4, 8, and 24 hours and 1 week later. MAIN OUTCOME MEASURES Intraocular pressure measurements. RESULTS The changes in postoperative IOP over time differed significantly between glaucoma, exfoliation syndrome, and normal (P = 0.005). Intraocular pressure was significantly lower in the normal group (n = 25) than in both the glaucoma (n = 18) and exfoliation syndrome (n = 19) groups (P<0.001). With 1 drop of prophylactic timolol maleate 0.5% at completion of surgery, the normal group (n = 25) again had IOP significantly lower than those of the glaucoma (n = 15) and exfoliation syndrome (n = 20) groups (P<0.001). Treatment with timolol maleate 0.5% significantly changed postoperative IOP over time in the glaucomatous eyes (P = 0.003), but it made no difference in the exfoliation syndrome (P = 0.4) or normal (P = 0.5) eyes. Intraocular pressure > 25 mmHg did not occur among normal eyes. Intraocular pressure > 25 mmHg and > 30 mmHg occurred in 10 (55%) and 5 (28%) glaucoma patients, respectively, and 5 (27%) and 2 (11%) exfoliation syndrome patients, respectively. Timolol maleate 0.5% eliminated IOP spikes > 30 mmHg and reduced the frequency of IOP > 25 mmHg in both groups to 14% in the glaucoma group and 5% in the exfoliation syndrome group. Most IOP elevation occurred at 4 hours postoperatively. The mean IOP was <20 mmHg in all groups 1 day postoperatively. CONCLUSIONS Medically well-controlled glaucoma patients and patients with exfoliation syndrome may experience IOP elevation shortly after cataract surgery. Instillation of timolol maleate 0.5% at the end of the procedure in this series eliminated IOP > 30 mmHg, but IOP elevation below that level can still occur.
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Borazan M, Karalezli A, Akman A, Akova YA. Effect of antiglaucoma agents on postoperative intraocular pressure after cataract surgery with Viscoat. J Cataract Refract Surg 2007; 33:1941-5. [DOI: 10.1016/j.jcrs.2007.06.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 06/16/2007] [Indexed: 10/22/2022]
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Anderson NG, Fineman MS, Brown GC. Incidence of Intraocular Pressure Spike and Other Adverse Events after Vitreoretinal Surgery. Ophthalmology 2006; 113:42-7. [PMID: 16360213 DOI: 10.1016/j.ophtha.2005.10.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2005] [Revised: 08/31/2005] [Accepted: 10/06/2005] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the incidence of significant postoperative intraocular pressure (IOP) elevation and other adverse medical events during the first postoperative day in patients undergoing inpatient vitreoretinal surgery. DESIGN Noncomparative interventional case series. PARTICIPANTS Two hundred two consecutive patients were admitted prospectively as inpatients after vitreoretinal surgery (vitrectomy and/or scleral buckling). METHODS Intraocular pressure was measured preoperatively, 5 to 12 hours postoperatively, and on postoperative day 1. Additionally, pain, nausea, and serious systemic adverse events were monitored. RESULTS Seventeen patients (8.4%) had a 5- to 12-hour IOP measurement above 29 mmHg. Thirty patients (14.8%) had a postoperative day 1 IOP measurement above 29 mmHg. Three patients (1.5%) required a parenteral narcotic to achieve adequate analgesia. Nine patients (4.5%) utilized a parenteral antiemetic for nausea control. Six patients (3.0%) had a hyperglycemic event. No serious systemic adverse events occurred in the early postoperative period. CONCLUSIONS The incidence of a significant IOP spike or systemic adverse events in the early postoperative period in patients undergoing vitreoretinal surgery is low.
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Rainer G, Menapace R, Schmid KE, Sacu S, Kiss B, Heinze G, Findl O. Natural Course of Intraocular Pressure after Cataract Surgery with Sodium Chondroitin Sulfate 4%–Sodium Hyaluronate 3% (Viscoat). Ophthalmology 2005; 112:1714-8. [PMID: 16199267 DOI: 10.1016/j.ophtha.2005.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 05/11/2005] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the natural course of intraocular pressure (IOP) and its peak after small-incision cataract surgery with chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat, Alcon Laboratories, Inc., Fort Worth, TX). DESIGN Observational case series. PARTICIPANTS This prospective study comprised 40 eyes of 40 consecutive cataract patients scheduled for small-incision cataract surgery. METHODS Cataract surgery was performed with sodium chondroitin sulfate 4%-sodium hyaluronate 3% as the ophthalmic viscosurgical device, which was removed as completely as possible from the eye at the end of surgery. The IOP was measured preoperatively and 30 minutes; 1, 2, 3, 4, 6, 8, and 20 to 24 hours; and 1 week postoperatively. MAIN OUTCOME MEASURES Postoperative IOP increase. RESULTS The mean IOP increased significantly at all observation times during the first 20 to 24 hours, with a peak increase of 13.4+/-9.4 mmHg after 1 hour (P<0.05). In all, 28 eyes (70%) had an IOP spike to 30 mmHg or higher. Sixty-eight percent of these spikes occurred at 30 minutes as well as at 1 hour and 2 hours postoperatively. At 20 to 24 hours, no eye had an IOP spike to 30 mmHg or higher. CONCLUSIONS Significant IOP increases were found during the first 24 hours, peaking at 1 hour after surgery. With a single postoperative IOP measurement, between 30 minutes and 2 hours after surgery, two thirds of these IOP spikes could be detected. To detect all IOP spikes, a second measurement between 4 and 6 hours after surgery would be necessary.
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Affiliation(s)
- Georg Rainer
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Cetinkaya A, Akman A, Akova YA. Effect of topical brinzolamide 1% and brimonidine 0.2% on intraocular pressure after phacoemulsification. J Cataract Refract Surg 2004; 30:1736-41. [PMID: 15313300 DOI: 10.1016/j.jcrs.2003.12.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To compare the effectiveness of brinzolamide 1% (Azopt) and brimonidine 0.2% (Alphagan) with a placebo in preventing an early increase in intraocular pressure (IOP) after phacoemulsification. SETTING Department of Ophthalmology, Baskent University, School of Medicine, Ankara, Turkey. METHODS In this prospective double-masked study, 90 eyes of 90 patients having clear corneal phacoemulsification were randomly divided into 3 groups of 30 eyes each. One hour before surgery, 1 group received 1 drop of brinzolamide 1%, another received 1 drop of brimonidine 0.2%, and the third received 1 drop of a balanced saline solution (placebo). The IOP was measured preoperatively and 3 and 16 to 20 hours postoperatively. RESULTS Three hours postoperatively, the mean IOP increased by 4.2 mm Hg +/- 7.0 (SD), 3.2 +/- 6.4 mm Hg, and 5.3 +/- 4.2 mm Hg in the brinzolamide, brimonidine, and placebo groups, respectively. The IOP increase from baseline was significant in all 3 groups (all P<.01), with no difference between the groups (P>.05). The change in IOP at 16 to 20 hours was 0.2 +/- 2.8 mm Hg, 0.2 +/- 2.4 mm Hg, and -0.8 +/- 2.4 mm Hg, respectively. The changes were not significant compared to baseline (all P>.05). Six eyes (20%) in the brinzolamide group, 5 eyes (16.7%) in the brimonidine group, and 7 eyes (23.3%) in the placebo group had an IOP higher than 25 mm Hg 3 hours postoperatively; the difference between groups was not significant (P =.8). CONCLUSION Prophylactic use of 1 drop of brinzolamide or brimonidine was not more effective than a placebo in controlling early postoperative IOP elevations after clear corneal phacoemulsification.
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Affiliation(s)
- Altuğ Cetinkaya
- Başkent University, School of Medicine, Department of Ophthalmology, Bahcelievler 06490, Ankara, Turkey
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Katsimpris JM, Siganos D, Konstas AGP, Kozobolis V, Georgiadis N. Efficacy of brimonidine 0.2% in controlling acute postoperative intraocular pressure elevation after phacoemulsification. J Cataract Refract Surg 2003; 29:2288-94. [PMID: 14709288 DOI: 10.1016/j.jcrs.2003.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the efficacy of brimonidine tartrate 0.2% drops given 2 times a day in reducing intraocular pressure (IOP) spikes during the first 24 hours after phacoemulsification cataract surgery. SETTING Department of Ophthalmology, General Hospital of Patras Agios Andreas, Patras, Greece. METHODS In this prospective double-blind placebo-controlled study, 1 eye of 40 consecutive normotensive cataract patients having small-incision cataract surgery was randomized into 1 of 2 treatment arms. Twenty patients received a placebo (artificial tears) and 20 patients received brimonidine tartrate 0.2% drops 2 times a day the day before and the day of surgery. Diurnal IOP variation was the primary efficacy variable; IOP was measured at baseline, before surgery, and 4, 6, 12, and 24 hours postoperatively. RESULTS The placebo group had higher IOPs at every time point after surgery. Peak elevation of IOP occurred 6 hours after surgery. The mean IOP in the placebo group (27.71 mm Hg +/- 3.75 [SD]) was statistically significantly higher than in the brimonidine group (21.45 +/- 1.32 mm Hg) (P<.001). A major IOP rise (>/=20 mm Hg above baseline IOP) occurred in 1 patient (5%) in the placebo group who required emergency hypotensive therapy. Twenty-four hours after surgery, 11 eyes (55%) in the brimonidine group and 4 eyes (20%) in the placebo group had an IOP lower than baseline. CONCLUSION Prophylactic treatment with brimonidine tartrate 0.2% 2 times a day for 2 days was effective in reducing IOP peaks throughout the first 24 hours after phacoemulsification surgery.
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Affiliation(s)
- John M Katsimpris
- Department of Ophthalmology, General Hospital Agios Andreas, Alexandroupoli, Greece.
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Browning AC, Alwitry A, Hamilton R, Rotchford A, Bhan A, Amoaku WM. Role of intraocular pressure measurement on the day of phacoemulsification cataract surgery. J Cataract Refract Surg 2002; 28:1601-6. [PMID: 12231319 DOI: 10.1016/s0886-3350(02)01279-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine whether measurement of intraocular pressure (IOP) preoperatively or in the early postoperative period is an accurate predictor of raised IOP 24 hours after cataract surgery. SETTING Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom. METHODS This prospective study comprised 101 eyes of 101 patients having phacoemulsification cataract surgery. The IOP was measured by Goldmann applanation tonometry preoperatively and 2 to 3 hours, 6 to 8 hours, and 22 to 24 hours postoperatively. The relationship between the same-day and next-day IOP readings was examined. RESULTS One hundred patients completed the study. The IOP at 22 to 24 hours was significantly correlated with the IOP preoperatively (correlation coefficient [r] 0.54; 95% confidence interval [CI], 0.38-0.67) and at 6 to 8 hours (r = 0.56; 95% CI, 0.41-0.68). In contrast, the IOP measurement at 2 to 3 hours correlated relatively poorly with the next-day IOP (r = 0.33; 95% CI, 0.14-0.49). Twelve patients had an IOP of 26 mm Hg or higher at 22 to 24 hours. The risk of this outcome increased significantly with higher IOP values preoperatively and, to a lesser extent, with a raised IOP at 6 to 8 hours. Glaucoma and ocular hypertension were associated with a 2.9-fold increased risk (95% CI, 0.67-12.8) of a next-day IOP of 26 mm Hg or higher. CONCLUSIONS Preoperative IOP or a diagnosis of glaucoma or ocular hypertension were significant risk factors for raised next-day IOP after small-incision phacoemulsification. It may be possible to select patients at greater risk of prolonged ocular hypertension before surgery for prophylactic IOP-lowering treatment. This would minimize patient morbidity and reduce the number of patients requiring next-day review, resulting in significant health economic savings.
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Affiliation(s)
- Andrew C Browning
- Department of Ophthalmology and Visual Sciences, Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham, United Kingdom
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Cataract surgical problem: Reply #7. J Cataract Refract Surg 2002. [DOI: 10.1016/s0886-3350(02)01550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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