Effect of a fixed dorzolamide–timolol combination on intraocular pressure after small-incision cataract surgery with Viscoat

Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis

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.

The safety and effectiveness of a new ophthalmic viscosurgical device-a randomized, controlled study

ClearVisc was significantly noninferior to Viscoat in the mean percentage of ECD loss from baseline to 3 months and proportion of patients with postoperative IOP ≥30 mm Hg at any follow-up.

To evaluate the safety and effectiveness of a new dispersive ophthalmic viscosurgical device (OVD) (ClearVisc) compared with an approved dispersive OVD (Viscoat) when used in cataract surgery.

Brinzolamide-brimonidine fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

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.

Non-Self-Sealing (Leaky) Anterior Chamber Paracentesis: A New Technique in Managing Postphacoemulsification Intraocular Pressure Rise in Glaucoma and Normal Eyes

Phacoemulsification (phaco) for cataract extraction is 1 of the most commonly performed ophthalmic surgeries. With increasing evidence of significant intraocular pressure (IOP) reduction after phaco, the paradigm for glaucoma treatment has been shifting toward more cataract extraction instead of glaucoma surgery; thus, the population of glaucoma patients undergoing phaco is likely to continue to increase in the coming years. Although the safety of surgery has improved over the years with newer technologies and machines, postoperative IOP spike remains an important condition even after an uneventful operation. Glaucoma patients undergoing phacoemulsification are particularly at risk of further glaucomatous optic nerve damage from the transient yet potentially high pressures after phaco. Common treatments include topical, intracameral, oral, and systemic IOP-lowering medications; postoperative anterior chamber paracentesis (ACP); and so on. No single treatment to date can guarantee effective prevention or control IOP rise in the first 24 hours after phaco. Sometimes, the IOP remains high despite all of the above treatments and the risk for further glaucomatous damage may be unavoidable. In this perspective article, we discuss the incidence, causes, and treatments of IOP rise after phaco and introduce a new technique, a non-self-sealing (leaky) ACP that may be of use in regulating postoperative IOP rise, especially for patients with glaucoma.

Effects of Topical Dorzolamide on IOP after Phacoemulsification with Different Types of Ophthalmic Viscosurgical Devices

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.

Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy

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.

Comparison of brimonidine-timolol and dorzolamide-timolol in the management of intraocular pressure increase after phacoemulsification

AIM

To compare the effectiveness of brimonidine/timolol fixed combination (BTFC) and dorzolamide/timolol fixed combination (DTFC) in the management of short-term intraocular pressure (IOP) increase after phacoemulsification surgery.

METHODS

Eighty eyes of 80 patients undergoing phacoemulsification and intraocular lens (IOL) implantation were randomly assigned into three groups. Group 1 consisted of 28 eyes and represented the control group. Group 2 consisted of 25 eyes undergoing phacoemulsification surgery and BTFC was instilled at the end of surgery. Group 3 consisted of 27 eyes undergoing phacoemulsification surgery and DTFC was instilled at the end of surgery. IOP was measured preoperatively and 6, 24h and 1wk postoperatively.

RESULTS

There was no statistically significant difference in preoperative baseline IOP among the three groups (P=0.84). However, IOP was significantly lower in groups 2 and 3 compared to the control group (P<0.05 for all comparisons) at all postoperative visits. There was no significant difference between groups 2 and 3 at any visit. Eight eyes (28.6%) in the control group, two (8%) in Group 2 and one (3.7%) in Group 3 had IOP >25 mm Hg at 6h after surgery (P=0.008). However, IOP decreased and was >25 mm Hg in only one eye in each group at 24h after surgery.

CONCLUSION

BTFC and DTFC have similar effects in reducing increases in IOP after phacoemulsification surgery and can both be recommended for preventing IOP spikes after such surgery.

Effect of 1% brinzolamide and 0.5% timolol fixed combination on intraocular pressure after cataract surgery with phacoemulsification

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.

Brinzolamide-timolol fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

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.

Efficacy of brimonidine in preventing intraocular pressure spikes following phacoemulsification in glaucoma patients

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.

Comparison of the effect of Viscoat and DuoVisc on postoperative intraocular pressure after small-incision cataract surgery

PURPOSE

To evaluate the effect of Viscoat (sodium chondroitin sulfate 4%-sodium hyaluronate 3%) and DuoVisc (Viscoat and Provisc [sodium hyaluronate 1%]) on postoperative intraocular pressure (IOP) after bilateral small-incision cataract surgery.

SETTING

Department of Ophthalmology, University of Vienna, Vienna, Austria.

METHODS

This prospective randomized study comprised 60 eyes of 30 consecutive patients with age-related cataract in both eyes. Each patient's eyes were randomly assigned to receive Viscoat or DuoVisc during cataract surgery. DuoVisc is a packet containing 2 ophthalmic viscosurgical devices (OVDs): the dispersive Viscoat, which was used for intraocular lens (IOL) implantation. In the Viscoat group, the Viscoat was used during the entire surgery. The intraocular pressure (IOP) was measured preoperatively as well as 1, 6, and 20 to 24 hours postoperatively.

RESULTS

One and 6 hours postoperatively, the mean IOP was significantly higher in the Viscoat group than in the DuoVisc group (25.8 mm Hg and 20.5 mm Hg, respectively, at 1 hour and 24.7 mm Hg and 21.1 mm Hg, respectively, at 6 hours) (P<.05). At 20 to 24 hours, the mean IOP was not statistically significantly different between the 2 groups. Intraocular pressure spikes to 30 mm Hg or higher occurred in 4 eyes in the DuoVisc group and 11 eyes in the Viscoat group (P<.05).

CONCLUSIONS

Viscoat caused significantly higher IOP increases and significantly more IOP spikes than DuoVisc in the early postoperative period. Therefore, if Viscoat is used during cataract surgery, an additional cohesive OVD should be used for IOL implantation.

Postoperative course of intraocular pressure after cataract surgery with combined primary posterior capsulorhexis and posterior optic buttonholing

PURPOSE

To evaluate the natural course of intraocular pressure (IOP) after cataract surgery with combined primary posterior continuous curvilinear capsulorhexis (PPCCC) and posterior optic buttonholing (POBH) of the intraocular lens (IOL) in adult patients.

SETTING

Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.

METHODS

Fifty consecutive patients with age-related cataract awaiting cataract surgery under topical anesthesia in both eyes were enrolled prospectively. In randomized order, cataract surgery with combined PPCCC and POBH was performed in 1 eye. In the fellow eye, cataract surgery was performed conventionally with in-the-bag IOL implantation and the posterior lens capsule kept intact. Standardized IOP measurements by Goldmann applanation tonometry were performed 1, 2, 4, 6, 8, and 24 hours postoperatively. Follow-up IOP measurements were taken at 1 week and 1 month. Twenty-five patients received 1-time IOP-lowering medication immediately after cataract surgery; the other 25 did not receive IOP-lowering drops.

RESULTS

During the first 24 hours postoperatively, no significant differences in IOP were observed between the PPCCC-POBH group and the conventional surgery group (P>.05). No IOP peaks greater than 27 mm Hg were observed in any eye. One week and 1 month postoperatively, no significant differences in IOP were found between groups (P>.05). The use of IOP-lowering drops significantly reduced postoperative IOP. However, no IOP spikes >27 mm Hg were found with and without the use of IOP-lowering drops.

CONCLUSION

The course of IOP after cataract surgery with combined PPCCC and POBH showed the technique to be as safe as conventional cataract surgery with in-the-bag IOL implantation.

Intraocular pressure and foveal thickness after phacoemulsification

PURPOSE

To evaluate the natural course of intraocular pressure (IOP) and foveal thickness during the postoperative period, and the correlation between them.

DESIGN

Prospective observational case series.

METHODS

This institutional study comprised 30 eyes of 30 cataract patients scheduled for phacoemulsification. IOP and foveal thickness by optical coherence tomography (OCT) were measured preoperatively and three, six, nine, 12, 15, 18, 21, 24 hours, five days, one month, and two months postoperatively.

RESULTS

The IOP was 4.7 +/- 2.4 mm Hg at three hours postoperatively. The IOP increased to 23.4 +/- 8.1 mm Hg at six hours and 23.5 +/- 7.3 mm Hg at nine hours postoperatively. The IOP was 1.9 mm Hg lower at one month or two months postoperatively than preoperatively. The foveal thickness was 202.1 +/- 19.2 microm and significantly higher at three hours postoperatively, and was 182.3 +/- 20.5 microm, 183.2 +/- 22.3 microm, and significantly lower at nine and 12 hours postoperatively than preoperatively. The correlation between mean IOP and mean foveal thickness is statistically significant. Fovea thickness (microns) = 207.0476 - 1.019759 x IOP (mm Hg), P value < .0001, adjusted R(2) = .8699.

CONCLUSIONS

We found initial hypotony, an IOP spike during six to nine hours, and a decrease of IOP at one month and two months postoperatively. An initial increase of the foveal thickness, a significant reduction at nine hours and 12 hours, and an equivocal increase at one month or two months postoperatively were also noted. A significant negative correlation between IOP and foveal thickness was shown.

Natural course of intraocular pressure after cataract surgery with sodium hyaluronate 1% versus hydroxypropylmethylcellulose 2%

PURPOSE

To investigate the natural course of intraocular pressure (IOP) after small-incision cataract surgery with sodium hyaluronate 1% versus hydroxypropylmethylcellulose 2%.

DESIGN

Randomized clinical trial.

PARTICIPANTS

Eighty eyes of 40 consecutive patients with bilateral age-related cataract.

METHODS

The patients were assigned randomly to receive sodium hyaluronate 1% or hydroxypropylmethylcellulose 2% during cataract surgery in the first eye. The second eye received the other ophthalmic viscosurgical device. 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 MEASURE

Postoperative IOP increase.

RESULTS

The highest mean IOP increase occurred at 8 hours postoperatively (5.3+/-6.4 mmHg) in the sodium hyaluronate 1% group and at 2 hours postoperatively (7.8+/-6.1 mmHg) in the hydroxypropylmethylcellulose 2% group. Overall, the IOP increase was higher with hydroxypropylmethylcellulose 2% (P = 0.005). Intraocular pressure spikes to > or =30 mmHg occurred in 5 eyes (13%) in the sodium hyaluronate 1% group and 13 eyes (33%) in the hydroxypropylmethylcellulose 2% group.

CONCLUSIONS

Sodium hyaluronate 1% and hydroxypropylmethylcellulose 2% caused significant IOP increases during the first 8 hours after cataract surgery. A single measurement at 6 hours postoperatively could detect all IOP spikes in the sodium hyaluronate 1% group. In the hydroxypropylmethylcellulose 2% group, a single measurement at 2 hours postoperatively could detect two thirds of IOP spikes.

Effect of bimatoprost on intraocular pressure after phacoemulsification in eyes with exfoliation syndrome

PURPOSE

To evaluate the effect of bimatoprost 0.03% on intraocular pressure (IOP) after phacoemulsification in eyes with exfoliation syndrome.

METHODS

This prospective, randomized, masked study comprised 90 eyes of 90 patients scheduled for phacoemulsification. The patients were divided into three groups (group 1 = without exfoliation, group 2 = with exfoliation syndrome, group 3 = exfoliation syndrome + bimatoprost). Immediately after phacoemulsification, one drop of bimatoprost was instilled in eyes in group 3. Baseline IOP was measured 1 day before surgery and routine follow-ups were performed at 6 hours, 20-24 hours and 1 week postoperatively.

RESULTS

Preoperative IOP was 15.0 +/- 2.7 mmHg in group 1, 15.6 +/- 3.2 mmHg in group 2 and 16.1 +/- 3.2 mmHg in group 3 (p = 0.372). Six hours postoperatively, there was a significant difference between the groups (p = 0.013): IOP in group 2 (22.4 +/- 7.3 mmHg) was higher than in group 1 (18.4 +/- 4.4 mmHg) (p = 0.018) and group 3 (18.9 +/- 4.9 mmHg) (p = 0.044). In all groups, IOP values at 6 hours postoperatively were higher than preoperative values (p < 0.001), but IOP values at 20-24 hours and 1 week after surgery were not significantly different from baseline values (p > 0.05). The change in IOP in group 2, from baseline to 6 hours postoperatively, was greater than the equivalent changes in group 1 (p = 0.048) and group 3 (p = 0.016).

CONCLUSIONS

Transient IOP increase and spikes were more common in eyes with exfoliation syndrome. Postoperative application of bimatoprost was effective in reducing IOP and preventing IOP spikes >/= 30 mmHg in eyes with exfoliation syndrome in the early postoperative period.

Natural Course of Intraocular Pressure after Cataract Surgery with Sodium Chondroitin Sulfate 4%–Sodium Hyaluronate 3% (Viscoat)

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.

Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification

PURPOSE

To evaluate the intraocular pressure (IOP) lowering effect of travoprost and brinzolamide within the first 24 h after phacoemulsification cataract surgery.

METHODS

This prospective, randomized, double-masked, controlled study comprised 90 eyes of 90 consecutive patients with senile cataract who had uneventful phacoemulsification surgery. Eyes in the first group received travoprost 0.0015%, second group received brinzolamide 1%. Eyes in the third group received balanced salt solution and were used as control. One drop was instilled immediately after surgery. IOP was measured 24 h preoperatively, 6 and 24 h postoperatively. Analysis of variance, Student's-t and chi2-tests were used for statistical analyses.

RESULTS

Preoperatively IOP was not significantly different among the three groups (P = 0.653). At 6 and 24 h postoperatively IOP was lower in both travoprost and brinzolamide group when compared to control group (P = 0.018 and 0.015 at 6 h, P = 0.010 and 0.007 at 24 h between travoprost and brinzolamide group was not significant (P = 0.744 at 6 h and P = 0.672 at 24 h).

CONCLUSION

Both travoprost and brinzolamide significantly lowered IOP after small incision phacoemulsification cataract surgery within the first 24 h without any side effect.