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.     

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 after small incision cataract surgery with Healon5 and Viscoat

PURPOSE: To evaluate the effect of Healon5 (sodium hyaluronate) and Viscoat (sodium chondroitin sulfate-sodium hyaluronate) on intraocular pressure (IOP) after bilateral small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective randomized study comprised 70 eyes of 35 consecutive patients with age-related cataract in both eyes scheduled for bilateral small incision cataract surgery. The patients were randomly assigned to receive Healon5 or Viscoat during cataract surgery in the first eye. The second eye received the other viscoelastic substance. Cataract surgery was performed in an identical fashion in both eyes, with a temporal 3.5 mm sutureless posterior limbal incision, phacoemulsification, and implantation of a foldable silicone intraocular lens. The IOP was measured preoperatively and 6 hours, 20 to 24 hours, and 1 week postoperatively. RESULTS: At 6 hours after surgery, the mean IOP increased by 5.2 mm Hg +/- 5.3 (SD) in the Healon5 group (P < .0001) and by 10.1 +/- 8.7 mm Hg in the Viscoat group (P < .0001). The increase was significantly higher in the Viscoat group than in the Healon5 group (P = .0016). Intraocular pressure spikes of 30 mm Hg or more occurred in 2 eyes in the Healon5 group and in 10 eyes in the Viscoat group (P = .0112). Twenty to 24 hours and 1 week postoperatively, the mean IOP in the 2 groups was not statistically different. CONCLUSIONS: Viscoat caused a significantly higher IOP increase and significantly more IOP spikes than Healon5 in the early period after small incision cataract surgery.     

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 dorzolamide and latanoprost on intraocular pressure after small incision cataract surgery

PURPOSE: To evaluate the effect of dorzolamide 2% and latanoprost 0.005% on intraocular pressure (IOP) after small incision cataract surgery. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This prospective study comprised 102 eyes of 102 consecutive patients scheduled for small incision cataract surgery. The patients were assigned preoperatively to 1 of 3 groups of 34 each: dorzolamide, latanoprost, and control (no treatment). One drop of the assigned medication was instilled immediately after surgery. Intraocular pressure was measured preoperatively and 6 and 20 to 24 hours postoperatively. RESULTS: Six hours after surgery, the mean increase in IOP was 1.9 mm Hg +/- 3.9 (SD) in the dorzolamide group (P = .004 versus control), 2.2 +/- 3.0 mm Hg in the latanoprost group (P = .005 versus control), and 4.8 +/- 5.2 mm Hg in the control group. Twenty to 24 hours postoperatively, IOP decreased a mean of -0.9 +/- 3.5 mm Hg in the dorzolamide group (P = .012 versus control) and increased a mean of 0.3 +/- 3.6 mm Hg in the latanoprost group (P = 0.24 versus control) and 1.3 +/- 4.2 mm Hg in the control group. One eye in the dorzolamide group, 1 eye in the latanoprost group, and 4 eyes in the control group had an IOP of 30 mm Hg or higher 6 hours postoperatively. CONCLUSION: Six hours postoperatively, dorzolamide and latanoprost were effective in reducing the IOP increase after small incision cataract surgery; however, at 20 to 24 hours, only dorzolamide was effective. Neither drug prevented IOP spikes of 30 mm Hg or higher.     

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.     

Intraocular pressure rise after primary posterior continuous curvilinear capsulorhexis with a fixed dorzolamide-timolol combination: randomized safety study with intraindividual comparison using an angulated and a nonangulated intraocular lens

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.     

A comparison of dorzolamide-timolol combination versus the concomitant drugs

PURPOSE: To compare the intraocular pressure (IOP) lowering effect of fixed combination dorzolamide 2% and timolol 0.5% therapy to that of concomitant administration of a topical beta-blocker and dorzolamide. METHODS: Seventy-four consecutive glaucoma patients were changed from a regimen including a topical beta-blocker and dorzolamide to the fixed combination dorzolamide-timolol in 1 eye, with the other eye used as the control. The average IOP readings before and 1 month after the change were compared. RESULTS: The mean baseline IOP in the entire study population was 19.4 +/- 4.2 mm Hg in the study eyes and 16.9 +/- 4.2 mm Hg in the control eyes. Four weeks after the medication change, the mean IOP was 17.3 +/- 3.9 mm Hg in the study eyes (P <.001) and 16.1 +/- 4.1 mm Hg in the control eyes (P =.02). The difference between the mean IOP change of 2.1 mm Hg in the study eyes and 0.8 mm Hg in the control eyes was found to be statistically significant (P =.01). CONCLUSION: These findings suggest that the fixed combination dorzolamide-timolol therapy achieves additional lowering of the intraocular pressure compared with the concomitant administration of a beta-blocker and dorzolamide.     

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.     

Combined endoscopic erbium:YAG laser goniopuncture and cataract surgery

PURPOSE: To study the safety and efficacy of endoscopic erbium:YAG (Er:YAG) laser goniopuncture combined with cataract surgery to treat glaucoma. SETTING: Department of Ophthalmology, Albert-Ludwigs-University Freiburg, Freiburg, Germany, and Institute of Applied Physics, University of Bern, Bern, Switzerland. METHODS: In this nonrandominized clinical trial, 20 eyes of 20 patients with cataract and glaucoma were treated by combined phacoemulsification and Er:YAG goniopuncture. The primary study endpoints were intraocular pressure (IOP), visual acuity, and number of antiglaucoma drugs 1 year after surgery. Two- and 3-year postoperative data were also measured. This prospective treatment arm was compared to a retrospective inclusion-matched control group treated by cataract surgery alone. RESULTS: The mean IOP dropped by 30% (23.5 mm Hg +/- 3.9 [SD] to 16.3 +/- 2.7 mm Hg) after 12 months in the laser-treated group (P<.0001) and by 9% (19.8 +/- 1.3 mm Hg to 18.1 +/- 1.8 mm Hg) in the control group (P =.12). After 3 years, the mean IOP in the laser group was 15.0 +/- 2.0 mm Hg. The mean number of antiglaucoma drugs needed decreased from 1.6 +/- 0.9 to 0.5 +/- 0.8 in the laser group (P<.0001) and from 1.0 +/- 0.9 to 0.8 +/- 0.9 in the control group (P =.21). Anterior chamber hemorrhage occurred in 12 eyes after laser treatment and resolved within 72 hours in all but 1 patient who was on warfarin sodium (Coumadin) therapy. There were no cases of hypotony in either group. CONCLUSIONS: Endoscopic Er:YAG laser goniopuncture was a successful adjunct to cataract surgery in glaucoma patients. Sustained IOP reduction was achieved with few postoperative complications.     

Effect of Healon and Viscoat on outflow facility in human cadaver eyes

PURPOSE: To compare the acute effects of Healon (sodium hyaluronate) and Viscoat (sodium chondroitin sulfate-sodium hyaluronate) on outflow facility in human cadaver eyes and determine which viscoelastic agent is least likely to cause an intraocular pressure (IOP) spike after cataract surgery. SETTING: The Glaucoma Research Lab, University of Toronto, Ontario, Canada. METHODS: In this prospective paired study, 15 pairs of human cadaver eyes were used. Following the construction of a 3.0 mm scleral tunnel, 0.25 cc of Healon was injected into the anterior chamber of 1 eye and 0.25 cc of Viscoat was injected into the contralateral eye. The viscoelastic agents were removed from both eyes in a standardized fashion and the scleral tunnels closed. The eyes were then perfused at a constant IOP of 8.0 mm Hg, corresponding to 16.0 mm Hg in vivo. Outflow facility (microL/minute [min]/mm Hg) was recorded every 15 minutes for 24 hours using standard methods. RESULTS: Outflow facility in the Viscoat-treated eyes decreased appreciably for the first 3 hours, then recovered somewhat after 12 hours; facility in the Healon-treated eyes showed less of an overall decrease. Over the 24 hour perfusion period, mean outflow facility was 0.037 microL/min/mm Hg +/- 0.015 (SD) in the Viscoat-treated eyes and 0.060 +/- 0.012 microL/min/mm Hg in the Healon-treated eyes. Healon reduced outflow facility significantly less than Viscoat between 3.25 and 10.50 hours postoperatively (P < .05, 2-tailed t test). CONCLUSIONS: Healon reduced outflow facility less than Viscoat between 3.25 and 10.50 hours postoperatively.     

Early postoperative spikes of the intraocular pressure (IOP) following phacoemulsification in late-stage glaucoma

BACKGROUND: Modern cataract surgery with use of viscoelastics can induce remarkable early spikes of the intraocular pressure (IOP) in patients with glaucoma. PATIENTS AND METHODS: The purpose of this prospective study was to investigate risk factors for an early increase of the IOP following cataract surgery in eyes with end-stage glaucoma. Clear cornea phacoemulsification with implantation of a foldable acrylic lens was performed in 25 eyes with end-stage glaucoma (primary open-angle glaucoma including normal tension glaucoma or exfoliative glaucoma) either under topical anesthesia or under general anesthesia. In eyes with exfoliative glaucoma, trabecular aspiration was performed additionally. IOP measurements were conducted at the day before surgery, 4 hours following surgery and on the first morning following surgery. RESULTS: Cataract surgery was performed without complications. The mean IOP was 18.5 +/- 4.2 mm Hg with 2.1 +/- 1.0 topical medications. 4 hours postoperatively, mean IOP was 31.3 +/- 11.9 mm Hg. In eyes with exfoliative glaucoma (n = 12) the early postoperative IOP was 28.5 +/- 12.0 mm Hg, but without significant difference compared to eyes with POAG (n = 13). The early postoperative IOP showed significant correlation with the maximum IOP in patient's history (p = 0.014). CONCLUSIONS: Patients with late-stage glaucoma can experience considerable early IOP spikes following uneventful cataract surgery, although preoperatively IOP is controlled by topical medications. Postoperative IOP monitoring is recommended at the day of surgery, especially if high IOP values are reported in patient's history.     

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. RESULTS: Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). CONCLUSIONS: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.     

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.     

Efficacy of anterior chamber decompression in controlling early intraocular pressure spikes after uneventful phacoemulsification

PURPOSE: To determine the efficacy of anterior chamber decompression in the management of intraocular pressure (IOP) spikes in the early period after uneventful phacoemulsification. SETTING: Royal Free Hospital, Department of Ophthalmology, Royal Free and University College London Medical School, London, United Kingdom. METHODS: This prospective case series comprised 11 consecutive patients with otherwise healthy eyes who an IOP of at least 40 mm Hg 4 to 6 hours after phacoemulsification. After anterior chamber decompression, the IOP was measured at 0, 15, 30, 45, and 60 minutes or until it exceeded 40 mm Hg. RESULTS: The mean IOP 4 to 6 hours postoperatively was 47.09 mm Hg +/- 7.92 (SD) (range 40 to 68 mm Hg). After decompression, the IOP dropped significantly to a mean of 4.73 +/- 3.00 mm Hg at 0 minutes (P<.001) and then increased progressively to 23.36 +/- 10.80 mm Hg at 15 minutes (P<.001), 33.82 +/- 11.74 mm Hg at 30 minutes (P=.005), 35.00 +/- 6.53 mm Hg at 45 minutes (P=.015), and 38.50 +/- 2.51 mm Hg at 60 minutes (P=.041). CONCLUSIONS: Marked IOP spikes developed in eyes without glaucoma or ocular hypertension after uneventful phacoemulsification. Anterior chamber decompression immediately lowered IOP, but the effect was transient.     

Intraocular pressure trends after supranormal pressurization to aid closure of sutureless cataract wounds

PURPOSE: To measure intraocular pressure (IOP) immediately and 25 minutes after small sutureless cataract surgery to estimate the duration of any elevation and to evaluate the relationship between supranormal pressurization and an elevated IOP 24 hours postoperatively. SETTING: Routine outpatient cataract surgery at a tertiary referral center. METHODS: Thirty-six consecutive eyes that had uneventful phacoemulsification cataract extraction were studied in a prospective fashion. Supranormal pressurization was attempted in all cases. Surgery was performed through a 3.5 mm scleral wound. RESULTS: Mean IOP dropped from 38.8 mm Hg +/- 11.4 (SD) to 19.8 +/- 5.3 mm Hg 25 minutes after the surgery (P < .0001). A subgroup of patients (n = 6) whose IOP was greater than 24 mm Hg 24 hours postoperatively had a pressure drop from 36.8 +/- 12.3 mm Hg to 23.2 +/- 6.2 mm Hg 25 minutes postoperatively (P = .051). In this subgroup, the mean 24 hour IOP then rose to 30.8 +/- 5.2 mm Hg (P = .043). Another subgroup of patients (n = 7) whose IOP was greater than 24 mm Hg at 25 minutes had a pressure drop from 46.3 +/- 8.5 mm Hg to 27.9 +/- 2.4 mm Hg (P = .0014), falling to 21.7 +/- 6.6 mm Hg at 24 hours (P = .018). CONCLUSION: These findings demonstrate the rapid decline of IOP after supranormal pressurization at the conclusion of cataract surgery. In addition, supranormal pressurization did not seem to contribute to IOP elevation at 24 hours.     

小切口小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的　探讨 3 5mm小切口小梁切除联合超声乳化白内障吸除后房型人工晶状体植入术 (三联手术 )治疗青光眼合并白内障患者的效果。方法　应用小切口三联手术对 2 0例 (2 6只眼 )青光眼合并白内障患者进行手术治疗。术后随访 3～ 41个月 ,平均 16 1个月。结果　术前平均眼压(2 3 0 1± 2 6 3)mmHg(1mmHg =0 133kPa) ,术后随访最终平均眼压降至 (13 93± 1 85 )mmHg(P <0 0 0 1)。术后随访最终矫正视力范围 0 0 5～ 1 0 ,其中≥ 0 6者 17只眼 (6 5 % ) ,术后平均散光度0 81D ,其中 4只眼无散光度。术后早期 2只眼使用降眼压药物 ,随访后期无使用者。术后早期并发症角膜水肿 5只眼 (19% ) ,浅前房 3只眼 (12 % ) ;晚期并发症后发性白内障 6只眼 (2 3% )。结论　小切口三联手术治疗青光眼合并白内障患者 ,具有恢复有用视力、稳定眼压、减少术后用药、并发症少等理想效果。     

Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation

PURPOSE: To evaluate intraocular pressure (IOP) after phacoemulsification and intraocular lens (IOL) implantation in nonglaucomatous eyes with and without exfoliation. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: One hundred ninety-six eyes that had phacoemulsification with IOL implantation were examined. Eyes with a history of intraocular disease or surgery that could affect IOP were excluded. The study comprised the remaining 160 eyes: 23 with exfoliation (EXF group) and 137 without exfoliation (non-EXF group). Follow-up data were available for 136 eyes. The same surgeon performed all surgeries. Patients were examined on the first postoperative day and after 1 week, 4 months, and 1.0 to 2.7 years. RESULTS: One day postoperatively, IOP rose in the EXF group from a mean preoperative level of 16.3 mm Hg +/- 2.7 (SD) to 21.0 +/- 8.5 mm Hg, a 28.4% increase (P =.0061). In the non-EXF group, mean IOP rose from 16.2 +/- 3.4 mm Hg to 20.5 +/- 5.7 mm Hg, a 29.9% increase (P =.001). In 4 eyes (17.4%) in the EXF group and 8 eyes (5.8%) in the non-EXF group, IOP increased to 30 mm Hg or higher at 1 day. After this, significant IOP decreases occurred in both the EXF and non-EXF group, respectively, as follows: 14.2 +/- 3.0 mm Hg (12.0% decrease from preoperative value; P =.001) and 15.0 +/- 2.9 mm Hg (5.9%; P =.001) 1 week postoperatively; 12.8 +/- 2.7 mm Hg (20.2%; P =.0002) and 13.8 +/- 2.7 mm Hg (13.2%; P =.001) after 4 months; and 12.3 +/- 2.6 mm Hg (23.2%; P =.0001) and 12.7 +/- 2.7 mm Hg (21.2%; P =.001) after 1.0 to 2.7 years. There was no significant difference between the 2 groups. CONCLUSION: After phacoemulsification with IOL implantation, IOP decreased significantly and remained lower than preoperatively in eyes with and without exfoliation. One day postoperatively, transient pressure peaks were more common in eyes with exfoliation. One eye without exfoliation developed glaucoma.     

Effect of a new cohesive ophthalmic viscosurgical device on corneal protection and intraocular pressure in small-incision cataract surgery

PURPOSE: To compare the corneal protective and intraocular pressure (IOP) effects of a new cohesive ophthalmic viscosurgical (OVD), Neocrom Cohesive (sodium hyaluronate 1.4%), with those of Healon (sodium hyaluronate 1.0%) in cataract surgery. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: This randomized patient-masked examiner-masked study with fellow-eye comparison comprised 29 cataract surgery patients. Surgery was performed with Neocrom Cohesive in 1 eye and Healon in the other eye. Central corneal thickness (CCT) was measured preoperatively and 1 day and 3 months postoperatively; endothelial cell density (ECD), preoperatively and 3 months postoperatively; and IOP, preoperatively and 6 hours and 1 day postoperatively. RESULTS: The mean CCT change from preoperatively to postoperatively in the Neocrom Cohesive, respectively, group and Healon group was +16.0 microm +/- 25.7 (SD) (P<.01) and +7.0 +/- 17.1 microm (P<.05), respectively, at 1 day and -5.7 +/- 10.8 microm (P<.01) and -4.7 microm +/- 9.5 microm) (P<.01), respectively, at 3 months. The mean ECD change at 3 months was 8 +/- 155 cells/mm(2) in the Neocrom Cohesive group (P = .8) and -46 +/- 139 cells/mm(2) in the Healon group (P = .08). The mean IOP increase was +2.2 +/- 3.5 mm Hg (P<.01) and +1.4 +/- 4.2 mm Hg (P = .14), respectively, 6 hours postoperatively and +0.9 +/- 4.3 mm Hg (P = .37) and 0.0 +/- 3.5 mm Hg (P = .77), respectively, at 1 day. CONCLUSION: There was no significant difference between Neocrom Cohesive and Healon in the changes in CCT, ECD, and IOP after cataract surgery.     

Phacoviscocanalostomy versus cataract surgery only in patients with coexisting normal-tension glaucoma: midterm outcomes

PURPOSE: To compare the midterm efficacy and safety of phacoviscocanalostomy (viscocanalostomy, phacoemulsification, and intraocular lens [IOL] implantation) and cataract surgery (phacoemulsification and IOL implantation) in patients with normal-tension glaucoma (NTG) and cataract. SETTING: Sensho-kai Eye Institute, Kyoto, Japan. METHODS: Thirty-one eyes had phacoviscocanalostomy, and 35 eyes had uncomplicated cataract surgery only. The intraocular pressure (IOP), postoperative antiglaucoma medications, and visual outcomes were compared between groups. RESULTS: The mean follow-up was 34.9 months+/-19.8 (SD) (range 7 to 78 months). At 36 months, the mean preoperative IOP and postoperative IOP were 17.2+/-1.5 mm Hg and 14.1+/-1.6 mm Hg, respectively, in the phacoviscocanalostomy group and 16.7+/-1.4 mm Hg and 15.6+/-3.4 mm Hg, respectively, in the cataract surgery only group. The differences between groups were significant at all time points (P<.05). The success probabilities of the phacoviscocanalostomy group achieving 20% and 30% IOP reductions with (or without) medications were 78.5% (67.4%) and 35.5% (37.4%) at 24 months and 58.0% (44.2%) and 28.0% (26.6%) at 48 months, which were significantly better than the probabilities in the cataract surgery only group, which were 16.0% (9.5%) and 5.7% (2.9%) at 24 months (P<.001 for each comparison, Kaplan-Meier life-table analysis with log-rank test). Based on the modified Aulhorn-Greve classification, the visual acuity and visual fields did not deteriorate in the phacoviscocanalostomy group; the visual fields deteriorated in 6 eyes in the cataract surgery only group during the follow-up (P=.024). CONCLUSION: Phacoviscocanalostomy lowered IOP and maintained postoperative visual outcomes; it was safe and effective in elderly patients with coexisting NTG and cataract.