Effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension after phacoemulsification and intraocular lens implantation

PURPOSE: To evaluate the effect of intracameral acetylcholine on latanoprost in preventing ocular hypertension in the early period after phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. SETTING: Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin, Hong Kong, China. METHODS: Patients with uncomplicated cataract having phacoemulsification with PC IOL implantation were included in this prospective randomized double-masked clinical trial. The eyes were randomly assigned to 1 of 4 groups based on postoperative application of latanoprost 0.005% alone (Group 1), latanoprost 0.005% with intracameral acetylcholine (Group 2), intracameral acetylcholine alone (Group 3), and no medication (controls (Group 4). Intraocular pressure (IOP) was measured 3 and 24 hours postoperatively. The anterior chamber was examined for the level of cells and flare using slitlamp biomicroscopy. RESULTS: Three and 24 hours after surgery, the decrease in mean IOP in eyes receiving latanoprost alone was not statistically significantly different from that in control eyes (P >.05). Eyes receiving intracameral acetylcholine alone had a significant decrease in the mean IOP at 3 hours (P <.05) but not at 24 hours compared to control eyes (P >.05). There were no significant differences in the mean postoperative IOP decrease between eyes receiving latanoprost with intracameral acetylcholine and those receiving intracameral acetylcholine alone (P >.05). CONCLUSIONS: A single application of latanoprost did not significantly lower IOP in the first 24 hours after phacoemulsification with PC IOL implantation. Eyes receiving intracameral acetylcholine alone had a significantly greater decrease in IOP than control eyes at 3 hours but not at 24 hours. The addition of intracameral acetylcholine to latanoprost did not enhance or reduce latanoprost's IOP-lowering effect.