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Y.G. Friedman, J.S. Schultz; Incidence of Intraocular Pressure Spike Post Cataract Extraction in Glaucoma Patients . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5484.
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To evaluate the incidence of intraocular pressure(IOP) spikes in glaucoma patients one day post cataract extraction, in an effort to determine whether cataract surgery or cataract surgery and trabeculectomy is more beneficial in this subset of patients.
Retrospective study of the pre and post–operative intraocular pressure of 46 eyes with a diagnosis of glaucoma. For the purpose of this study, patients were included if they required two or more agents for IOP control. Patients who had prior trabeculectomies were excluded from the study. The patients all underwent clear corneal phaco–emulsification cataract extraction by a single surgeon. Patients were taking an average of 2.9 agents to control IOP pre–operatively. Patients were asked to continue taking their IOP lowering drops in the evening and morning following their surgery.
The range of pre–operative IOP was 8 to 25 mm Hg with a mean pre–operative IOP of 14.87 mm Hg. The range of first day post–operative pressure was 8 to 52 mm Hg with a mean IOP of 16.56 mm Hg. Only two eyes experienced a post–operative pressure spike of greater than 25 mm Hg with one eye having an IOP measuring 50 mm Hg and the other patient having an IOP of 52 mm Hg. The average post–operative IOP excluding these two outliers was 14.95 mm Hg. There was a mean increase in IOP of 1.69 mm Hg when comparing pre and post–operative IOP. There was a 4% incidence of IOP spike greater than 25 mm Hg. The P value comparing the difference between pre and post–operative pressures was .247, not reaching statistical significance.
Cataract surgery alone in patients with known glaucoma, on two or more medications, can be considered a safe and reasonable procedure. The decision of a trabeculectomy can be deferred until the patient’s disease is progressing despite maximal tolerated medical therapy. This stepwise approach does not put the patient at risk for a significant rise in post–operative intraocular pressure.
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