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Wonmo Gu, Sooncheol Cha, Suho Lim, Jihee Chu, Min Sagong; Risk Factors for Early Postoperative Intraocular Pressure Elevation after Phacoemulsification in Trabeculectomized Eyes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6129.
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The purpose of this study is to investigate the frequency and risk factors for early postoperative intraocular pressure (IOP) elevation after phacoemulsification in patients with prior trabeculectomy.
We performed a retrospective chart review of 200 eyes (172 patients, study group) with filtering bleb after previous trabeculectomy and 207 eyes (144 patients, control group) without previous trabeculectomy, who underwent temporal clear corneal phacoemulsification with posterior chamber lens implantation. Eleven possible risk factors including age, gender, type of glaucoma, interval from trabeculectomy to phacoemulsification, axial length, preoperative IOP, preoperative bleb morphology (height, vascularity), glaucoma medication and concomitant intraoperative procedures (iris manipulation, anterior vitrectomy) were analyzed to identify independent risk factors by multivariate logistic regression method. Early postoperative IOP elevation was defined as IOP value ≥ 25 mm Hg or IOP increase ≥ 10 mm Hg the next morning after surgery compared to preoperative IOP.
There was a significant difference in frequency of IOP elevation between the study group (25 eyes, 12.5%) and control group (6 eyes, 2.9%)(p<0.001). The mean early postoperative IOP (15.2±6.7 mm Hg) was significantly higher than preoperative IOP (12.5±4.4 mm Hg) in study group (p<0.001). Risk factors for early postoperative IOP elevation were low bleb height (OR=11.104, p=0.001) and iris manipulation (OR=5.082, p=0.020) in study group while risk factors were preoperative use of glaucoma medication (OR=3.492, p=0.004) and iris manipulation (OR=34.249, p=0.009) in control group.
Phacoemulsification increases the risk of IOP spike in prior trabeculectomized eyes, especially which had low bleb height and intraoperative iris manipulation. We suggest intraoperative and postoperative efforts to minimize intraocular inflammation and earlier follow up examination in these patients.
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