Incidence of preoperative high blood pressure in cataract surgery among hypertensive and normotensive patients

Early intervention for perioperative hypertension in cataract surgery

PURPOSE

Although perioperative blood-pressure control is important, especially for high-risk patients, no previous report has examined early monitoring of perioperative blood-pressure changes before cataract surgery. In this single-center, retrospective, observational study, we evaluated the early intervention for perioperative hypertension in cataract surgery with topical anesthesia.

METHODS

Hospitalized patients who underwent phacoemulsification and intraocular-lens insertion and whose blood pressure was controlled using standardized management to start early monitoring and control (standardized group; 134 eyes of 134 patients) were compared to age- and sex-matched patients who underwent the same cataract surgery and whose blood pressure was controlled using conventional means (control group; 134 eyes of 134 patients). The perioperative blood pressure, pulse pressure, and heart rate were compared preoperatively, upon entering the operation room, and at the beginning, end, and after the operation.

RESULTS

Although there was no difference before the operation, the changes in systolic pressure in the standardized group were significantly lower at the point of entering the operation room, at the beginning of the operation, and at the end of the operation (P = 0.003, < 0.001, and < 0.001, respectively). No significant difference was observed between etizolam and nicardipine use.

CONCLUSION

Early monitoring and control of blood pressure in cataract surgery could effectively control perioperative hypertension without additional drug use and could be widely applied in the clinical setting.

Is perioperative blood pressure monitoring during intravitreal injections important?

Background:

Anti-vascular endothelial growth factor intravitreal injections (IVIs) have proved to be a boon for patients suffering from several retinal pathologies. They are one of the most commonly performed procedures in ophthalmology. A perioperative rise in blood pressure (BP) has been noted during cataract surgery.

Objectives:

To evaluate the perioperative BP changes during IVI, and the associated risk factors.

Design:

Cross-sectional observational study

Methods:

The patients undergoing IVI from May 2019 to August 2019 were evaluated. All the patients underwent BP measurement before, during, and 1 h after the IVI. The correlation between the demographics and, the systemic comorbidities of the patients, and the ocular condition for which IVI was given was evaluated.

Results:

The study included 302 patients (mean age of 59.9 ± 10.7 years). The mean increase in systolic BP (SBP) and diastolic BP (DBP) at the time of injection was 25.7 ± 21.0 and 1.3 ± 13.4 mmHg, respectively. A ⩾ 10, ⩾ 20, ⩾ 30 mmHg increase in SBP at the time of injection was seen in 83.8% (n = 253), 69.5% (n = 210) and 49.0% (n = 148) patients, respectively. Forty-one (13.6%) patients developed intra-procedural hypertensive urgency, out of which six patients (14.6%) did not recover even after 1 h of the procedure. None of the patients experienced any cardiovascular events. The univariate and multivariate linear regression analyses showed that the change in intra-procedural SBP correlated positively with the age of the patient and negatively with the baseline SBP.

Conclusion:

There is a significant rise of SBP at the time of IVI, especially in patients with advanced age and high baseline SBP. Some of the patients can experience hypertensive urgency at the time of injection and may take more than 1 h to recover. The patients receiving IVI should undergo a detailed physician evaluation before the procedure.

Effect of Metabolic Syndrome on Blood Pressure Changes During Cataract Surgery

PURPOSE

To investigate effect of metabolic syndrome on blood pressure during cataract surgery with topical anesthesia.

DESIGN

A single-centered, retrospective case series.

METHODS

Consecutive patients who were hospitalized and underwent phacoemulsification and insertion of intraocular lens with topical anesthesia in October 2016 were included. Perioperative blood pressure and pulse pressure were compared between patients with metabolic syndrome (metabolic group) and sex- and age-matched patients without metabolic syndrome (nonmetabolic group) at six time points: on admission, in the morning of the operation, 2 hours before the operation, at the point of entering the operation room, during the operation, and after the operation. Perioperative use of etizolam and nicardipine was compared between the two groups.

RESULTS

Thirty patients in the metabolic group and 30 in the nonmetabolic group were included. There was no difference in changes compared with the values on admission in systolic pressure and pulse pressure at any examination point between the two groups. There was no difference in changes in diastolic pressure between the two groups, except for at 2 hours before the operation (1.4 ± 9.6 mm Hg in the metabolic group vs -6.2 ± 8.5 mm Hg in the nonmetabolic group; P = 0.044). The number of patients who were administered etizolam was 5/30 (16.7%) in the metabolic group and 2/30 (6.7%) in the nonmetabolic group, showing no significant difference. No patients were administered intravenous nicardipine in either group.

CONCLUSIONS

Well-controlled metabolic syndrome did not affect the changes in perioperative blood pressure during cataract surgery with topical anesthesia.

Cinnamaldehyde Attenuates Cataractogenesis via Restoration of Hypertension and Oxidative Stress in Fructose-Fed Hypertensive rats

OBJECTIVES

Several studies have revealed that systemic hypertension is strongly associated with cataractogenesis. However, the pathophysiology and treatment is often unclear. In this study, we evaluated the anti-cataractogenic effect of cinnamaldehyde (CA), a natural organic compound, in rats with fructose-induced hypertension.

METHODS

The rats were divided into six groups. For six weeks, the normal group received a suspension of 0.5% carboxy methyl cellulose (10 mL/kg/day, p.o.) while five other groups received a 10% (w/v) fructose solution in their drinking water to induce hypertension. By the end of the third week hypertension had been induced in all the animals receiving fructose. From the beginning of the fourth week to the end of the sixth week, one of those five groups (control) continued to receive only 10% (w/v) fructose solution, one group (standard) received ramipril (1 mg/kg/day, p.o.) plus 10% (w/v) fructose solution, and three groups (experimental) received CA at doses of 20, 30, and 40 mg/kg/day p.o., plus 10% (w/v) fructose solution. Blood pressure was measured weekly using a non-invasive blood pressure apparatus. After six weeks, the animals were sacrificed, and the anti-cataractogenic effects on the eye lenses were evaluated.

RESULTS

Administration of fructose elevated both the systolic and the diastolic blood pressures, which were significantly reduced by CA at all dose levels. In the control group, a significant increase in the malonaldehyde (MDA) level and decreases in the total protein, Ca(2+)adenosine triphosphate (ATP)ase activity, glutathione peroxidase, catalase, superoxide dismutase and glutathione levels, as compared to the normal group, were observed. Administration of CA at all doses significantly restored the enzymatic, non-enzymatic, antioxidants, total protein, and Ca(2+)ATPase levels, but decreased the MDA level, as compared to the control group.

CONCLUSION

The present study revealed that CA modulated the antioxidant parameters of the serum and lens homogenates in hypertension-induced cataractogenic animals.