Evaluation of intraocular pressure with Healon and Healon GV in sutureless cataract surgery with foldable lens implantation

Impact of Ophthalmic Viscosurgical Devices in Cataract Surgery

Background

Ophthalmic viscoelastic devices (OVDs) used during small-incision cataract surgery have numerous advantages. However, OVDs have longer retention time in an eye after surgery resulting in intraocular pressure (IOP) spikes. The purpose of this study is to analyze and quantify the effect of various OVDs on both IOP and best corrected visual acuity (BCVA) by systematically reviewing the literature and performing meta-analysis.

Methods

Numerous databases from January 1, 1985, to present were systematically searched. Thirty-six (3893 subjects) of 3313 studies identified were included for analysis. Standardized mean difference (SMD) was computed, and meta-analysis was performed.

Results

A total of 3313 records were retrieved including 1114 from database search and 2199 from grey literature search. Significant increase in postoperative IOP in 1-day follow-up with Healon (SMD = 0.37, CI: [0.07, 0.67]), Viscoat (SMD = 0.29, CI: [0.13, 0.45]), Provisc (SMD = 0.46, CI: [0.17, 0.76]), and Soft Shell (SMD = 0.58, CI: [0.30, 0.86]) was computed. On the other hand, results implied a nonsignificant increase in postoperative IOP with Healon GV (SMD = 0.07, CI: [−0.28, 0.41]), Healon5 (SMD = 0.15, CI: [−0.33, 0.64]), 2% HPMC (SMD = 0.32, CI: [−0.0, 0.64]), and OcuCoat (SMD = 0.26, CI: [−0.37, 0.9]). Additionally, a nonsignificant reduction in postoperative IOP was inferred with Viscoat + Provisc (SMD = −0.28, CI: [−2.23, 1.68]).

Conclusion

Improvement in IOP was shown with Viscoat + Provisc. Additionally, IOP nonsignificant upsurge was observed with Healon GV, Healon5, 2% HPMC, and OcuCoat compared to significant upsurge with Healon, Viscoat, and Soft Shell.

Cataract phacoemulsification performed by resident trainees and staff surgeons: intraoperative complications and early postoperative intraocular pressure elevation

PURPOSE

To determine the incidence of intraoperative complications of phacoemulsification cataract surgery in a teaching hospital and to compare the intraoperative complication rate between resident trainees and staff ophthalmologists, to ascertain the overall rate of intraocular pressure (IOP) elevation on postoperative day 1 (POD1), and, again, to compare this value between resident trainees and staff surgeons.

SETTING

Centro Hospitalar São João, Oporto, Portugal.

DESIGN

Retrospective study.

METHODS

This study included eyes submitted for phacoemulsification cataract surgery from January 1, 2017, to December 31, 2017. There were no exclusion criteria. Data collected included the type of surgeon, level of resident training, case complexity, and intraoperative complications. From all noncomplicated surgeries, preoperative IOP and IOP-POD1 were collected.

RESULTS

A total of 2937 surgeries were included; 25.6% were performed by resident trainees. The complication rate was 6.3% with resident trainees and statistically significantly lower (3.3%) in staff surgeons. The complication rate of resident trainees did not differ according to their level of residency. There was a significantly increased incidence of IOP-POD1 elevation in the resident trainee group compared with the staff surgeon group. Surgeries performed by resident trainees, a preexisting history of glaucoma, and pseudoexfoliation were significant risk factors for IOP elevation.

CONCLUSIONS

To our knowledge, this is the first European study comparing the incidence of intraoperative and postoperative complications in cataract surgery performed by resident trainees and staff surgeons. We report a significantly higher rate of intraoperative complications and IOP elevation on POD1 in resident trainees vs staff surgeons.

Prophylactic treatment of intraocular pressure elevation after uncomplicated cataract surgery in nonglaucomatous eyes - a systematic review

The purpose of this systematic review was to evaluate the literature regarding prophylactic treatment of intraocular pressure (IOP) elevation after uncomplicated cataract surgery to provide an evidence-based guideline for cataract surgeons. The relevant literature was identified in EMBASE and PubMed. The risk of bias was assessed according to the 'Cochrane Handbook for Systematic Reviews of Interventions' and the ROBINS-I tool. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) criteria were used to rate the quality of evidence, and relevant data were systematically extracted to evaluate the pressure-lowering effect of the active substances. The primary outcomes for this systematic review were the absolute and relative pressure-lowering effect of the different drugs after 3-8 hr and 1 day after surgery. In total, 23 randomized controlled trials and one nonrandomized controlled study consisting of 45 treatment arms with 14 different active substances were included in the qualitative synthesis. According to the GRADE criteria, nine trials were graded as 'high' quality of evidence, 12 trials as 'moderate', while three trials were given the grade 'low' quality of evidence. The primary outcomes showed most consistency between the trials, which studied the effect of timolol, and presented a relative effect from 18.6% to 29.6% at 3-8 hr and 9.8% to 23.6% at day 1. This systematic review indicates that timolol, latanoprost and travoprost alone or medications containing timolol as an additive active substance, such as dorzolamide + timolol, brinzolamide + timolol and brimonidine + timolol, are characterized by a good relative IOP-lowering effect, which can be gained by a single dose postoperatively.

Intraocular pressure control after trans-scleral intraocular lens fixation in glaucoma patients

BACKGROUND

Intraocular lens fixation surgery is associated with fluctuations in intraocular pressure. This may be significantly relevant in glaucoma patients.

OBJECTIVES

To assess short- and medium-term intraocular pressure control after trans-scleral intraocular lens fixation surgery in glaucoma patients.

METHODS

The charts of all glaucoma patients who underwent trans-scleral intraocular lens fixation surgery with at least 6 months follow-up by a single surgeon between the years 2004 and 2017 were reviewed. Primary outcomes were intraocular pressure at 1 day and 6 months after surgery. Secondary outcome measures were hypotensive medication use and the need for further intraocular pressure lowering interventions.

RESULTS

Eleven eyes of 10 patients were included in the analysis. Mean follow-up post intraocular lens fixation surgery was 54.6 months. Mean intraocular pressure before, 6 months, and last follow-up after intraocular lens fixation surgery was 15.8 ± 5.3 mmHg (range 10.6-25.3), 13.5 ± 3.8 mmHg (range 8-21, p = 0.2), and 11.8 ± 5.6 (range 6-21, p = 0.09) on a mean of 2.3 ± 1.6, 2 ± 1.6 (p = 0.23), and 1.7 ± 1.5 (p = 0.08) hypotensive medications, respectively. A pressure spike was noted in 5 of the 11 eyes on the first post-operative day (mean spike 15.2 mmHg, range 6-23). Four of 11 eyes in the study (36%) needed additional interventions to control intraocular pressure by the 6-month point. One eye required the addition of two classes of topical medications, one eye required laser trabeculoplasty, and two eyes required trabeculectomy.

CONCLUSION

Over a third of glaucomatous eyes required a change in the management of their disease in the early post-operative period. Close follow-up of patients undergoing trans-scleral intraocular lens fixation surgery is warranted.

Intraocular Pressure (IOP) Change and Frequency of IOP Spike After Cataract Surgery in Normal-tension Glaucoma: A Case-Control Study

PURPOSE

To evaluate the early-postoperative intraocular pressure (IOP) changes and frequency of IOP spike after cataract surgery in normal-tension glaucoma (NTG) eyes and to compare them with those of nonglaucomatous eyes.

MATERIALS AND METHODS

This was a case-control study. We reviewed the medical records of patients who had undergone cataract surgery. One-to-one (1:1) case matching was performed, each matched set consisting of 1 NTG and 1 nonglaucomatous eye as the control eye. Comparisons between those 2 groups were performed. Specifically, IOP was measured preoperatively and 1 day, 1, 2, and 4 weeks postoperatively. The incidence of IOP spike was evaluated according to the criteria of IOP higher than 21, 25, 30 mm Hg, higher than 5, 10 mm Hg over baseline IOP, and 50% above preoperative IOP.

RESULTS

A total of 298 eyes (149 NTG eyes and 149 control eyes) were enrolled. Preoperative IOP did not show any significant difference between the 2 groups (P=0.687). IOP significantly decreased in both the NTG and control groups [P<0.001, repeated-measures analysis of variance (ANOVA)]. No significant differences in this regard were detected between the 2 groups (P=0.618, repeated-measures ANOVA). When IOP spike was evaluated according to the 6 criteria, the frequencies were <3% at any timepoint. There was no significant difference between the 2 groups.

CONCLUSIONS

In both the NTG and control groups, IOP gradually decreased in the early-postoperative period after cataract surgery, and there was no significant difference between the 2 groups. The frequency of IOP spike was <5% in both the NTG group and the control group.

Early postoperative intraocular pressure elevation following cataract surgery

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.

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.

Changes in Corneal Biomechanics and Intraocular Pressure Following Cataract Surgery

PURPOSE

To investigate the effects of cataract surgery on corneal biomechanics and intraocular pressure (IOP) measured with the updated Corvis ST tonometer (CST).

DESIGN

Prospective, interventional case series study.

METHODS

This study included 39 eyes of 39 cataract patients. CST measurements were performed at presurgery (Pre) as well as 1 week (1W), 1 month (1M), and 3 months (3M) postsurgery. The following CST parameters were recorded: deformation amplitude max (DA max), DA ratio max 1 mm and 2 mm, integrated radius, stiffness parameter at applanation 1 (SP A1), Ambrosio relational thickness to the horizontal profile (ARTh), Corvis biomechanical index (CBI), central corneal thickness (CCT), noncorrected intraocular pressure (IOPnct), and biomechanically corrected IOP (bIOP). IOP was also measured with Goldmann applanation tonometry and the noncontact tonometer CT-90A. All measurements were compared at each period using the linear mixed model, with and without adjustment for bIOP and CCT.

RESULTS

All IOP measurements decreased over time (P < .01). CCT was increased at 1W and 3M (P < .01), whereas ARTh was decreased at 1W and 1M (P < .01), but returned to its Pre level at 3M. DA max and Integrated radius were increased at 3M (P < .01), whereas SP A1 was decreased at 3M (P < .01). CBI was increased at 1W (P < .01), but returned to its Pre level at 1M.

CONCLUSIONS

IOP and Corneal biomechanical properties are changed after cataract surgery. In particular, SP A1 decreases while DA max and integrated radius increase, even at 3M, suggesting a less stiff cornea.

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.

First Day Review after Uncomplicated Phacoemulsification: Is it Necessary?

PURPOSE

To determine whether first day follow-up is necessary after routine uncomplicated phacoemulsification cataract surgery.

METHODS

Data collected prospectively at day 1 postoperative review.

RESULTS

In 510 consecutive cases, serious complications occurred in 8 (1.6%) (wound leak [4], corneal abrasion [2], iris prolapse [1], hyphema [1]). Intraocular pressure (IOP) >30 mmHg was found in 26 (5.1%) and was strongly associated with a diagnosis of pre-existing glaucoma or ocular hypertension (odds ratio [OR] 7.7). Symptoms of headache or ocular discomfort occurred in 40 (7.8%), mostly in association with raised IOP, and were also associated with pre-existing glaucoma or ocular hypertension (OR 4.7). Central corneal edema was found in 61 (12.0%). In the absence of corneal edema, IOP was >30 mmHg in only two cases (0.39%).

CONCLUSIONS

Few sight-threatening complications were detected on the morning after an uncomplicated procedure. First day follow-up may be safely omitted if adequate patient counseling is undertaken and there is provision of adequate access to eye services. Review prior to discharge on the day of surgery would provide an opportunity to detect these few surgical complications and for counseling. A diagnosis of glaucoma or ocular hypertension is a risk factor for significantly raised next day IOP and these patients are more likely to experience postoperative discomfort. They may benefit from prophylactic treatment.

Evaluation of a new method of irrigation and aspiration for removal of ophthalmic viscoelastic device during cataract surgery in a porcine model

BACKGROUND

To determine if a method for irrigation and aspiration (I/A) during cataract surgery provides effective removal of ophthalmic viscoelastic device (OVD).

METHODS

Japanese porcine eyes were used to evaluate I/A performance with Technique 1 (the I/A tip placed on the center of the anterior surface of the IOL), Technique 2 (the I/A tip alternately pressed near the edge of the IOL optic anterior surface on one side and then the other to tilt the IOL back and forth), and Technique 3 (the I/A tip inserted behind the IOL optic, between it and the posterior capsule). Techniques 1 and 2 were compared using the Miyake-Apple posterior view video technique to visualize the flow of irrigation fluid containing triamcinolone acetonide particles behind the IOL. To check the efficacy of OVD removal from behind the IOL for of all three I/A techniques, OVD with fluorescein beads were inserted inside the lens capsule before implantation of the IOL. After each I/A technique, eyes were prepared for Miyake-Apple viewing and pictures of the lens capsule were taken using fluorescent microscopy. Residual fluorescein beads in the capsular bag were analyzed.

RESULTS

Technique 1 resulted in a straight flow of fluid behind the IOL, while Technique 2 resulted in a vortex flow. The average amount of OVD retained inside the capsule after using Technique 2 or 3 was significantly lower than after using Technique 1 (p <0.0001).

CONCLUSIONS

Technique 2 proved to remove more effectively fluorescein bead-labelled OVD under the IOL than Technique 1.

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.

Intraocular pressure elevation during early postoperative period after secondary intraocular lens implantation in children and adolescents

PURPOSE

To look at the intraocular pressure (IOP) spike in the early postoperative period after secondary intraocular lens (IOL) implantation in children.

SETTING

Miles Center for Pediatric Ophthalmology, Medical University of South Carolina, South Carolina, USA.

DESIGN

Retrospective chart review.

METHODS

The postoperative day-1 examination of patients having secondary IOL implantation by the same surgeon was reviewed for an IOP greater than 26 mm Hg. In patients with an IOP spike, the medical history and examination findings that might be associated with the rise were evaluated.

RESULTS

Review of 85 patient charts (133 eyes) identified 9 eyes that developed an IOP spike during the early postoperative period. Six eyes were symptomatic, with symptoms including pain, ocular discomfort, nausea, and emesis, and 6 eyes had preoperative aphakic glaucoma, which was controlled with medication. Six of 22 eyes (27%) with preoperative aphakic glaucoma and 3 of 111 eyes (3%) without glaucoma (P<.001) developed an acute IOP rise (relative risk, 10.1).

CONCLUSIONS

The high incidence of a symptomatic early IOP spike in patients with aphakic glaucoma warrants meticulous ophthalmic viscosurgical device removal at the end of surgery, consideration of the routine use of prophylactic topical and/or systemic glaucoma medication, and monitoring during the early postoperative period.

Increased intraocular pressure on the first postoperative day following resident-performed cataract surgery

PURPOSE

The aim of this study was to investigate the incidence of intraocular pressure (IOP) elevation after resident-performed cataract surgery and to determine variables, which influence postoperative day 1 (POD1) IOP.

METHODS

In all, 1111 consecutive cataract surgeries performed only by training residents between 1 July 2001 and 30 June 2006 were included. Elevated IOP was defined as ≥23 mm Hg. Surgeries were classified according to the presence of POD1-IOP elevation. Fisher's exact test and Student t-test were used to compare both groups. Multivariate analyses using generalized estimating equations were performed to investigate predictor variables associated with POD1-IOP elevation.

RESULTS

The average preoperative IOP was 16.0±3.2 mm Hg and the average POD1-IOP was 19.3±7.1 mm Hg, reflecting a significant increase in IOP (P<0.001, paired t-test). The incidence of POD1-IOP elevation ≥23 mm Hg was 22.0% (244/1111). Presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length were frequently encountered variables in the POD1-IOP elevation group (all P<0.05). Using a multivariate analysis, presence of glaucoma (P=0.004, OR=2.38; 95% confidence interval (95% CI)=1.31-4.30), presence of ocular hypertension (P=0.003, OR=6.09; 95% CI=1.81-20.47), higher preoperative IOP (P<0.001, OR=3.73; 95% CI=1.92-7.25), and longer axial length (P=0.01, OR=1.15; 95% CI=1.03-1.29) were significant predictive factors for POD1-IOP elevation.

CONCLUSIONS

IOP elevation on the first postoperative day following resident-performed cataract surgery occurred frequently (22.0%). Increased early postoperative IOP was associated with presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length.

Comparison of OVD and BSS for maintaining the anterior chamber during IOL implantation

PURPOSE

To compare surgical results between conventional intraocular lens (IOL) implantation using an ophthalmic viscosurgical device (OVD) and IOL implantation using a balanced salt solution (BSS) after irrigation/aspiration (I/A) of the lens cortex.

METHODS

A randomized prospective study was conducted on 62 patients who underwent cataract surgery. Following completion of conventional I/A of the lens cortex, we divided patients into two groups according to whether or not BSS was used. In group A (n = 31), the anterior chamber and the capsular bag were completely filled with an OVD before IOL implantation. On the other hand, in group B (n = 31), BSS was irrigated into the anterior chamber through a previous side port during IOL implantation. Surgical results were compared between the two groups.

RESULTS

In both groups, IOP peaked six hours after surgery. The occurrence of an IOP spike by postoperative day one was observed in six cases (6 / 31) in group A and in no cases (0 / 31) in group B, a difference that was statistically significant (p = 0.024). The values of endothelial cell density, central corneal thickness, anterior chamber inflammation, myopic shift, and posterior capsule opacification were not significantly different between the two groups.

CONCLUSIONS

Compared with the use of OVD for IOL implantation, use of BSS during IOL implantation resulted in reductions in postoperative IOP spike and OVD removal time.

Oral versus topical carbonic anhydrase inhibitors in ocular hypertension after scleral tunnel cataract surgery

Purpose:

To compare the effect of oral acetazolamide and topical 2% dorzolamide in prevention of ocular hypertension after scleral tunnel cataract surgery.

Setting:

Ophthalmic department, Sana’a University, Yemen Sana’a from March 2007 to October 2007.

Methods:

This prospective double-blind, randomized study included 150 eyes undergoing scleral tunnel cataract surgery with hard posterior chamber intraocular implantation. Methylcellulose was used as the viscoelastic in all surgery cases. Patients were assigned to one of three groups: group 1: topical gentamicin eye drops (control; n = 52); group 2: systemic acetazolamide 250 mg (n = 45); and group 3: topical 2% dorzolamide (n = 53). Acetazolamide patients received one 250 mg tablet, one hour before surgery, then half a tablet every eight hours. A topical dorzolamide 2% or gentamicin was applied in one drop one hour before surgery then every eight hours, for three days postoperatively. Intraocular pressures (IOP) were measured by Goldman applanation tonometry one hour preoperatively and 16, 24, and 48 hours postoperatively.

Results:

At 16 hours, IOP between the three groups increased significantly with a statistically significant p-value of 0.008, but the mean IOP of acetazolamide patients was less than other groups. IOP nearly returned to the normal level 24 and 48 hours postoperatively, but this was not statistically significant (p = 0.452 and 0.138, respectively).

Conclusion:

Acetazolamide offers better IOP control than topical dorzolamide 2% in preventing ocular hypertension after scleral tunnel cataract surgery.

Comparision of the effects of subtenon’s and subconjunctival anesthesia on retroorbital hemodynamics

The aim of the study was to compare retroorbital blood flow hemodynamics between subconjunctival and sub-Tenon’s anesthesia. This was a prospective, blinded study and included 80 cases. Patients were monitored and treated in the First Ophthalmology Clinic, Ataturk Training and Research Hospital, Turkey. Sub-Tenon’s anesthesia was performed in 42 cases, and subconjunctival anesthesia was performed in 38 cases. Color Doppler imaging to measure ocular blood flow parameters was performed preoperatively and 21 days after cataract operation in each case. Preoperative and postoperative values of resistivity and pulsatility indices in the ophthalmic, central retinal, and short posterior ciliary arteries were compared. Postoperative mean blood flow velocity measurements of ophthalmic artery were not statistically different between the subconjunctival anesthesia group and the sub-Tenon’s anesthesia group (49.63 ± 14.00 vs. 45.85 ± 13.41; P=0.389). Postoperative RI values were higher in the Subtenon’s anesthesia group than in the subconjunctival anesthesia group, but the difference between two groups was not statistically significant (0.81 ± 0.14 vs. 0.74 ± 0.08; P=0.079). The postoperative pulsatility index of the ophthalmic artery, RI of ophthalmic artery, pulsatility index of the central retinal artery, RI of the central retinal artery, and pulsatility index of the posterior ciliary arteries were not significantly different between the subconjunctival and sub-Tenon’s anesthesia groups. In conclusion, the study suggests that postoperative retroorbital blood flow hemodynamics are the same following sub-Tenon’s and subconjunctival anesthesia.

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.

Intraocular pressure rise after primary posterior continuous curvilinear capsulorhexis with a fixed dorzolamide–timolol combination

PURPOSE

To assess the safety, in terms of the intraocular pressure (IOP), of cataract surgery with primary posterior continuous curvilinear capsulorhexis (PPCCC) and a postoperative dose of a fixed dorzolamide-timolol combination and evaluate the effect of intraocular lens (IOL) haptic angulation.

SETTING

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

METHODS

In this prospective randomized double-masked bilateral study, 88 eyes of 44 consecutive patients with age-related cataract were included in an intraindividual comparison study. All patients had standardized cataract surgery with PPCCC and IOL implantation in the capsular bag followed by a postoperative dose of a fixed dorzolamide-timolol combination. Patients were randomly assigned to receive an ACR6D SE IOL (Laboratoires Cornéal) in 1 eye and a Centerflex (C-flex) 570C IOL (Rayner Surgical GmbH) in the contralateral eye. The IOP was measured at baseline and postoperatively at 6 and 24 hours as well as 1 week.

RESULTS

Intraindividual comparison showed statistically significantly higher IOP measurements in the C-flex 570C nonangulated IOL group than in the ACR6D SE angulated IOL group at 24 hours (P = .003) and 1 week (P = .043). The highest IOP spikes (34 mm Hg) were at 6 hours in 2 eyes with a C-flex 570C IOL. The ACR6D SE group had statistically significant changes in IOP between preoperative and all postoperative time points. In the C-flex 570C group, the only statistically significant change in IOP was between preoperatively and 6 hours postoperatively.

CONCLUSIONS

Cataract surgery with PPCCC was safe in terms of the postoperative IOP course. Haptic angulation slightly decreased the overall IOP rise and the incidence of IOP rises above 30 mm Hg.

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.

Change in intraocular pressure within 1 week of phacoemulsification and intraocular lens implantation using Adatocel

PURPOSE

To examine the change in intraocular pressure (IOP) within 1 week of phacoemulsification and foldable posterior chamber intraocular lens (PC IOL) implantation using Adatocel (hydroxypropyl methylcellulose 2% [HPMC]).

SETTING

Department of Ophthalmology, University of Sciences, Faculty of Medicine, Pécs, Hungary.

METHODS

In this prospective study, the IOP in 118 eyes of 118 patients (57 men, 61 women, mean age 68 years +/- 7.8 [SD]) with no history of glaucoma was assessed by Goldmann applanation tonometry 2 to 3, 6 to 8, and 22 to 24 hours and 1 week after uneventful phacoemulsification and PC IOL implantation. The effect of the removal of Adatocel ("partial removal" from the anterior chamber [AC] only versus "complete removal" from behind of the IOL as well), the lens type (Medicontur 601 HP versus Bausch & Lomb Hydroview), and the type of anesthesia (topical versus parabulbar) were compared. Statistical analysis was performed using the Student t test, and P< or =.05 was considered statistically significant.

RESULTS

The mean preoperative IOP was 13.83 +/- 2.5 mmHg. There were no significant differences at any time in postoperative IOP measurements between the 2 IOL types and the 2 modes of anesthesia. At 2 to 3 hours, 6 to 8 hours, and 22 to 24 hours, the IOP was significantly higher in the 30 eyes in which the Adatocel was partially removed (from the AC only) than in the 88 eyes in which it was completely removed (from behind the PC IOL as well) (P< or =.05, P< or =.01, and P< or =.001, respectively).

CONCLUSION

Severe postoperative IOP spikes in nonglaucomatous patients after uneventful phacoemulsification cataract surgery are rare. The type of implanted PC IOL and the mode of anesthesia had no significant effect on postoperative IOP. Total removal of the ophthalmic viscosurgical device, even when using HPMCs such as Adatocel, is necessary to prevent postoperative IOP spikes.

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.

Use of trypan blue for penetrating keratoplasty

Use of trypan blue for penetrating keratoplasty was developed to facilitate the procedure. Trypan blue is injected before and after the addition of 0.25 mL of an ophthalmic viscosurgical device (OVD), sodium hyaluronate, to stain the internal and external cut edge of the cornea as well as the OVD, enabling the surgeon to improve visualization of the incision and suture depth, improve alignment of host and donor tissues, and ensure that all OVD is removed.

Corneal edema and intraocular pressure after cataract surgery: randomized comparison of Healon5 and Amvisc Plus

PURPOSE

To compare the protective effect of Healon5 (sodium hyaluronate 2.3%) and Amvisc Plus (sodium hyaluronate 1.6%) against corneal edema and their association with postoperative intraocular pressure (IOP) spikes in patients having phacoemulsification and intraocular lens (IOL) implantation.

SETTING

Ophthalmology department of a general hospital.

METHODS

One hundred forty patients were randomly assigned to have surgery with Healon5 (n = 70) or Amvisc Plus (n = 70). One eye of each patient was analyzed. Data collected preoperatively included best corrected visual acuity (BCVA) and IOP. Central ultrasonic pachymetry was performed in all patients. The same ophthalmologist performed all surgeries. The IOP and central corneal thickness (CCT) were measured 1 and 4 days and 1 month after surgery. The BCVA was also assessed at 1 month.

RESULTS

There were no significant preoperative differences between the Healon5 and Amvisc Plus groups in sex, age, ocular pathology, BCVA, IOP, or CCT. Intraoperative variables were similar between groups, but it took significantly longer to remove the Healon5. Postoperatively, there were no differences between groups in the evolution of CCT or of IOP. Intraocular pressure spikes over 30 mm Hg were detected at 1 day in 7 patients in the Healon5 group and 2 patients in the Amvisc Plus group (10.0% versus 2.9%; P = .165).

CONCLUSIONS

Both OVDs were beneficial in a wide range of cataract patients. However, the results suggest a tendency toward a higher complication rate with Healon5.

Effect of topical brinzolamide 1% and brimonidine 0.2% on intraocular pressure after phacoemulsification

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.

Intraocular pressure rise after phacoemulsification surgery in glaucoma patients

PURPOSE

To examine the changes in intraocular pressure (IOP) and the incidence of substantial rises in IOP in the early period after cataract surgery in eyes with open-angle glaucoma (OAG).

SETTING

Hayashi Eye Hospital, Fukuoka, Japan.

METHODS

The study included 32 eyes of 32 patients with OAG and 31 control eyes of 31 age-matched patients scheduled for phacoemulsification surgery. The IOP was measured preoperatively and 1, 2, 3, 5, 7, 14, and 28 days postoperatively. The incidence of a substantial rise in IOP postoperatively was evaluated, with the criterion being an IOP higher than 30 mm Hg.

RESULTS

In the OAG group, the mean IOP increased 1, 2, and 3 days postsurgery and then decreased, whereas in the control group, it decreased from day 1 postsurgery. Although no significant differences were found between groups preoperatively, the mean IOP in the OAG group was significantly higher than in the control group postoperatively. Furthermore, the mean IOP decrease was also less in the OAG group than in the control group. A substantial increase in IOP occurred at day 1 postsurgery in 4 eyes (12.5%) in the OAG group, whereas no eyes in the control group showed such an increase; this difference was significant (P =.0419).

CONCLUSIONS

A substantial increase in IOP occurred in an approximately 13% of eyes with OAG 1 day after phacoemulsification surgery. The IOP shortly after surgery was significantly greater in the eyes with OAG than in nonglaucomatous eyes.

Empty-bag technique for acrylic intraocular lens implantation using Healon5

PURPOSE

To determine how often the empty-bag technique (EBT) for injecting an acrylic foldable intraocular lens (IOL) into the capsular bag using Healon5 (sodium hyaluronate 2.3%) will require a 2-compartment technique to remove the ophthalmic viscosurgical device (OVD) and compare this with that of a standard injection method using Healon5.

SETTING

Cincinnati Eye Institute and Ambulatory Surgical Center, Cincinnati, Ohio, USA.

METHODS

Forty-one eyes of 40 patients were randomly assigned to 1 of 2 groups. In Group A, standard capsular bag expansion was performed with Healon5 before implantation of an acrylic posterior chamber (PC) IOL. In Group B, Healon5 was placed in the anterior chamber followed by balanced salt solution expansion of the capsular bag before acrylic PC IOL implantation. In all patients, complete OVD removal was attempted with the automated aspiration tip anterior to the optic (rock 'n roll technique). The number of patients in each group who required placement of the aspiration tip posterior to the optic for complete removal was compared. Early postoperative intraocular pressure (IOP) was also compared.

RESULTS

In Group A, 15 (75%) of 20 eyes required placement of the aspiration tip posterior to the optic for complete OVD removal and in Group B, 1 (0.05%) of 20 eyes. The postoperative IOP was similar in both groups.

CONCLUSIONS

The EBT decreased the likelihood that a 2-compartment OVD removal method would be necessary when using Healon5 for acrylic PC IOL implantation. The limitations of this new technique must be fully understood before it is used.

Removal times and techniques of a viscoadaptive ophthalmic viscosurgical device

PURPOSE

To analyze removal techniques for Healon5 (sodium hyaluronate 2.3%).

SETTING

Center for Research on Ocular Therapeutics and Biodevices, Charleston, South Carolina, USA, and Department of Ophthalmology, Ruprecht-Karls-University, Heidelberg, Germany.

METHODS

In a standardized laboratory setup, the Miyake-Apple posterior view video technique in human autopsy eyes was used to evaluate removal of an ophthalmic viscosurgical device (OVD) from capsular bags implanted with poly(methyl methacrylate), silicone, and acrylic intraocular lenses (IOLs). Healon5 was stained with fluorescein for better visualization. Open-sky preparation and an Alcon Legacy Series 20000 phaco machine with a flow rate of 25 mL/minute and a vacuum setting of +500 mm Hg (maximum irrigation/aspiration [I/A]) were used. With Technique 1, the I/A tip was placed on the center of the IOL and maximum aspiration was applied. With Technique 2 (modified rock 'n roll technique), the I/A tip was moved in quick circular movements on top of the IOL to break the OVD chains and facilitate aspiration.

RESULTS

With Technique 1, the mean removal time was 59.0 seconds +/- 23.1 (SD) and with Technique 2, 23.6 +/- 10.3 seconds (P =.004). The removal time of Healon5 correlated with the IOL material. With Technique 2, removal was fastest with silicone IOLs (13.5 +/- 2.1 seconds) followed by PMMA IOLs (17.5 +/- 2.1 seconds). With acrylic IOLs, remnants of the OVD trapped behind the IOL optic resulted in a longer removal time of 34.1 +/- 1.2 seconds.

CONCLUSIONS

Healon5 was completely removed from the capsular bag with the modified rock 'n roll technique. With acrylic IOLs, remnants can be trapped behind the optic and may be overlooked with an unstained OVD. Aspiration behind the optic is recommended with this IOL type.

Relationship of immediate intraocular pressure rise to phaco-tip ergonomics and energy dissipation

PURPOSE

To evaluate the rise in intraocular pressure (IOP) after phacoemulsification using a straight microtip or a Kelman microtip and its relationship to phaco energy delivered to the eye.

SETTING

Iladevi Cataract & IOL Research Center, Ahmedabad, India.

METHODS

This prospective randomized study comprised 48 consecutive age- and sex-matched patients with senile cataract. Inclusion criteria included older than 45 years and presence of any type of cataract from grade I to III. The patients were divided into 2 groups: straight microtip and Kelman microtip. Each group comprised 13 men and 11 women. The mean age was 58.29 years +/- 6.46 (SD) in the straight microtip group and 60.05 +/- 8.45 years in the Kelman microtip group. The IOP was measured preoperatively and postoperatively with a pneumotonometer and applanation tonometer. One surgeon performed all operations using a standardized surgical technique and topical anesthesia. The intraoperative mean phaco power and ultrasound (US) time were noted. The effective phaco time (EPT), percentage of IOP rise, and wound-site thermal injury (mild, moderate, or severe) were calculated. The correlation between the EPT and percentage of rise in IOP was evaluated using correlation coefficients and the paired t test.

RESULTS

The mean preoperative IOP was 13.73 +/- 2.89 mm Hg in the straight microtip group and 15.14 +/- 2.60 mm Hg in the Kelman microtip group. The mean US time was 239.4 +/- 1.61 seconds and 238.2 +/- 1.48 seconds, respectively. The mean phaco power was 17.37% +/- 3.28% in the straight microtip group and 17.10% +/- 5.26% in the Kelman microtip group and the mean EPT, 39.06 +/- 2.28 seconds and 40.08 +/- 0.24 seconds, respectively (P =.412). The mean rise in IOP was 111.60% +/- 37.83% in the straight microtip group and 91.29% +/- 31.85% in the Kelman microtip group. The difference between groups was significant (P<.05). The correlation coefficient between the EPT and percentage of IOP rise was significant in both groups: 0.3823, straight microtip group (P<.05); 0.514, Kelman microtip group (P<.01). Wound-site thermal injury was noted in 3 patients in the straight microtip group and 1 patient in the Kelman microtip group.

CONCLUSIONS

Although the amount of phaco energy dissipated in the eye was the same between the 2 groups, the percentage of IOP rise was greater with the straight microtip. The rise in IOP was correlated with the dissipated phaco energy.

Efficacy of brimonidine 0.2% in controlling acute postoperative intraocular pressure elevation after phacoemulsification

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.

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

PURPOSE

To evaluate the effect of a fixed dorzolamide-timolol combination (Cosopt) on intraocular pressure (IOP) after small-incision cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat).

SETTING

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

METHODS

This prospective randomized study comprised 76 eyes of 38 patients scheduled for small-incision cataract surgery in both eyes. Patients were randomized to receive 1 drop of the fixed dorzolamide-timolol combination in 1 eye or no treatment (control) immediately after cataract surgery. The fellow eye received the other assigned treatment. Cataract surgery was performed with Viscoat in an identical fashion in both eyes. The IOP was measured preoperatively and 6 hours, 20 to 24 hours, and 1 week postoperatively.

RESULTS

Six hours after surgery, the mean increase in IOP was significantly lower in the dorzolamide-timolol group than in the control group (4.3 mm Hg +/- 5.6 [SD] versus 8.4 +/- 6.1 mm Hg; P =.003). Two eyes in the dorzolamide-timolol group and 9 in the control group had IOP spikes of 30 mm Hg or higher (P =.022). Twenty to 24 hours after surgery, the mean IOP change was -2.6 +/- 3.3 mm Hg in the dorzolamide-timolol group and 1.5 +/- 3.2 mm Hg in the control group (P<.001).

CONCLUSIONS

The fixed dorzolamide-timolol combination was effective in reducing IOP 6 hours and 20 to 24 hours after cataract surgery. However, it did not prevent Viscoat-induced IOP spikes of 30 mm Hg or higher.

Role of intraocular pressure measurement on the day of phacoemulsification cataract surgery

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.

Short-term blood-aqueous barrier breakdown after implantation of the 1CU accommodative posterior chamber intraocular lens

PURPOSE

To quantify intraocular inflammation after phacoemulsification with implantation of an accommodative posterior chamber intraocular lens (IOL).

SETTING

Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.

METHODS

Twenty cataractous eyes of 20 patients without preexisting blood-aqueous barrier (BAB) deficiencies or previous intraocular surgery were included in this study. The mean age of the patients was 64.6 years +/- 16.0 (SD). A single surgeon performed phacoemulsification through a superior sclerocorneal tunnel incision and implantation of a 1CU IOL (HumanOptics AG) though a 3.2 mm incision. The haptics of the single-piece acrylic 1CU lens are designed for anterior optic movement following ciliary muscle contraction. The postoperative treatment was standardized. Postoperative BAB breakdown was quantified by laser flare photometry (FC-1000, Kowa) at 1 day, 1 and 4 weeks, and 3 and 6 months.

RESULTS

The mean aqueous flare was 6.3 photons/ms +/- 3.0 (SD) (range 4.0 to 12.2 photons/ms) 1 day postoperatively, with 64% of patients having normal aqueous flare values (<8.0 photons/ms). One week after surgery, the mean aqueous flare was 5.3 +/- 2.8 photons/ms (range 2.0 to 10.5 photons/ms). Four weeks postoperatively, aqueous flare was normal in all patients and remained stable below the normal limit for up to 6 months (mean 3.3 +/- 1.2 months; range 2.0 to 5.4 months). The number of aqueous cells did not increase at any follow-up and was normal in all eyes. No postoperative complications such as fibrin formation, synechias, macrophages on the IOL optic, or endophthalmitis were observed.

CONCLUSIONS

Phacoemulsification with implantation of the 1CU accommodative IOL led to minimal and short-lasting BAB alteration. No signs of persistent inflammation or pigment dispersion were detected.

Effect of topical brimonidine on intraocular pressure after small incision cataract surgery

PURPOSE

To evaluate the effect of brimonidine 0.2% on intraocular pressure (IOP) after small incision cataract surgery.

SETTING

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

METHODS

This prospective randomized study comprised 80 eyes of 40 patients scheduled for small incision cataract surgery in both eyes. In each patient, 1 eye was randomly assigned to receive 1 drop of brimonidine 0.2% or no treatment (control) immediately after surgery. The fellow eye received the other assigned treatment. All patients had standardized surgery by the same surgeon with sodium hyaluronate 1%, a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively.

RESULTS

Six hours after surgery, the mean increase in IOP was 4.7 mm Hg +/- 6.1 (SD) in the brimonidine group and 4.6 +/- 5.3 mm Hg in the control group. In each group, 17 eyes (43%) had an IOP increase of 5 mm Hg or more. Twenty to 24 hours after surgery, the mean increase in IOP was 1.5 +/- 4.2 mm Hg in the brimonidine group and 1.6 +/- 4.4 mm Hg in the control group. There were no statistically significant between-group differences at any measurement.

CONCLUSIONS

In both groups, IOP significantly increased 6 hours and 20 to 24 hours after small incision cataract surgery. Brimonidine 0.2% failed to reduce the IOP increase observed after small incision cataract surgery.

Intraindividual comparison of the effects of a fixed dorzolamide-timolol combination and latanoprost on intraocular pressure after small incision cataract surgery

To compare the effect of a fixed dorzolamide-timolol combination with that of latanoprost on intraocular pressure (IOP) after small incision cataract surgery. Department of Ophthalmology, University of Vienna, Vienna, Austria. This prospective randomized study comprised 60 eyes of 30 patients scheduled for small incision cataract surgery in both eyes. The patients were randomly assigned to receive 1 drop of a fixed dorzolamide-timolol combination or latanoprost immediately after cataract surgery in the first eye. The second eye received the other antiglaucomatous agent. Cataract surgery was performed under sodium hyaluronate 1% with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable intraocular lens. The IOP was measured preoperatively as well as 6 and 20 to 24 hours and 1 week postoperatively. Six hours after surgery, the mean IOP decreased by -0.8 mm Hg +/- 3.2 (SD) (P =.184) in the dorzolamide-timolol group and increased by 3.6 mm Hg +/- 3.5 (P <.001) in the latanoprost group. Twenty to 24 hours after surgery, the mean IOP decreased by -2.8 +/- 2.4 mm Hg (P <.001) in the dorzolamide-timolol group and increased by 0.6 +/- 3.5 mm Hg (P =.353) in the latanoprost group. The differences between groups were significant at 6 hours (P <.001) and 20 to 24 hours (P <.001). The fixed dorzolamide-timolol combination was more effective than latanoprost in reducing IOP after small incision cataract surgery. Only the fixed dorzolamide-timolol combination prevented a postoperative IOP increase and occasional IOP spikes of 30 mm Hg or higher.

Intraocular pressure rise after small incision cataract surgery: a randomised intraindividual comparison of two dispersive viscoelastic agents

AIM

To evaluate the effects of the dispersive viscoelastic agents Ocucoat (hydroxypropyl methylcellulose 2%) and Viscoat (sodium chondroitin sulphate 4%-sodium hyaluronate 3%) on postoperative intraocular pressure (IOP) after bilateral small incision cataract surgery.

METHODS

This prospective, randomised study comprised 80 eyes of 40 consecutive patients with age related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Ocucoat or Viscoat during cataract surgery of the first eye. The second eye was operated later and received the other viscoelastic agent. Cataract surgery was performed with a temporal 3.2 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively as well as 6 hours, 20-24 hours, and 1 week postoperatively.

RESULTS

At 6 hours after surgery the mean IOP increased by 4.6 (SD 5.1) mm Hg in the Ocucoat group (p<0.001) and by 8.6 (8.1) mm Hg in the Viscoat group (p<0.001). The increase was significantly higher in the Viscoat group than in the Ocucoat group (p=0.004). Intraocular pressure spikes of 30 mm Hg or more occurred in two eyes in the Ocucoat and in nine eyes in the Viscoat group (p=0.023); 20-24 hours and 1 week postoperatively the mean IOP was not statistically different.

CONCLUSION

These findings indicate that Viscoat causes a significantly higher IOP increase and significantly more IOP spikes than Ocucoat in the early period after small incision cataract surgery.

Effect of Healon5 and 4 other viscoelastic substances on intraocular pressure and endothelium after cataract surgery

PURPOSE

To compare the ophthalmic viscoelastic device (OVD) Healon5 (sodium hyaluronate 2.3%) with 4 other commonly used OVDs during phacoemulsification and intraocular lens implantation in terms of influence on intraocular pressure (IOP) postoperatively and endothelial cells preoperatively and postoperatively.

SETTING

Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Germany.

METHODS

This clinical randomized prospective study, in which patients and observer were masked, comprised 81 eyes. Seventy-four eyes (mean patient age 71.2 years +/- 7.8 [SD]) completed all preoperative and 5 postoperative examinations. The OVDs used were OcuCoat and Celoftal (hydroxypropyl methylcellulose 2.0%), Viscoat (sodium hyaluronate 3.0%-chondroitin sulfate 4.0%), Healon GV (sodium hyaluronate 1.4%), and Healon5 (sodium hyaluronate 2.3%). Intraocular pressure was measured by standard Goldmann applanation tonometry preoperatively and 4 to 6 and 24 hours and 7, 30, and 90 days postoperatively. Endothelial cell counts were done preoperatively and 90 days postoperatively using a Pro/Koester WFSCM contact endothelial microscope. Exclusion criteria were IOP greater than 21 mm Hg at the preoperative examination, age younger than 40 years, significant corneal pathology, and a history or presence of uveitis or pseudoexfoliation syndrome.

RESULTS

All groups had increased IOP 4 hours postoperatively. The Healon5 group had the highest mean pressure (24.9 mm Hg) followed by the Viscoat group (23.6 mm Hg). The mean IOP in the other OVD groups was less than 22.1 mm Hg. These differences were not significant. Twenty-four hours postoperatively and at all subsequent examinations, mean IOP was below 20 mm Hg. The Healon5 group had the lowest mean endothelial cell loss (6.2%), significantly lower than in the other groups (P < .02).

CONCLUSION

With all 5 OVDs, endothelial cell loss was found, with the lowest in the Healon5 group, and IOP was increased 4 to 6 hours postoperatively. After 24 hours, no significant increases in IOP were noted.

Randomised fellow eye comparison of the effectiveness of dorzolamide and apraclonidine on intraocular pressure following phacoemulsification cataract surgery

PURPOSE

To compare the effectiveness of 2% dorzolamide and 0.5% apraclonidine on intraocular pressure (IOP) following phacoemulsification cataract surgery.

METHODS

This prospective, randomised study comprised 54 eyes of 27 consecutive patients with age-related cataract scheduled for cataract surgery in both eyes. In each patient the eye with the higher degree of cataract was randomly assigned to receive one drop of either dorzolamide or apraclonidine immediately after surgery. The fellow eye was operated on later and received the other treatment. Cataract surgery was performed with a superior 6.0 mm sutureless frown incision, phacoemulsification and implantation of a three-piece PMMA intraocular lens. The IOP was measured pre-operatively as well as 6 h and 20-24 h and 1 week post-operatively.

RESULTS

The mean pre-operative IOP was not significantly different between the groups (dorzolamide group, 14.9 +/- 2.3 mmHg; apraclonidine group, 14.6 +/- 2.5 mmHg; p = 0.450). At 6 h post-operatively, the mean IOP was significantly lower in the dorzolamide than in the apraclonidine group (15.6 +/- 3.9 mmHg vs 18.0 +/- 4.0 mmHg; p < 0.001). An IOP increase of more than 5 mmHg at 6 h post-operatively occurred in 3 (12%) eyes in the dorzolamide group and in 9 (36%) eyes in the apraclonidine group (p = 0.034). At 20-24 h post-operatively and at 1 week post-operatively no difference was found between the groups.

CONCLUSIONS

2% Dorzolamide is more effective than 0.5% apraclonidine in preventing the early post-operative IOP increase following phacoemulsification cataract surgery.