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Asher Weiner, Yotam Weiner; Acute Intra-ocular Pressure (IOP) Changes Following Cataract Surgery With and Without Trabectome™ Ab-interno Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4779.
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© ARVO (1962-2015); The Authors (2016-present)
To determine whether the use of Trabectome™ may help protect eyes at risk from acute IOP elevations during the immediate post-operative period following cataract surgery.
A retrospective interventional non-randomized comparative chart review. Main outcome measures were IOP 3-4 hours and 20 hours following surgery. Brimonidine 0.1% was used in all eyes at the end of surgery, following the 3-4 hour IOP check, and before the 20-hour IOP check.
We identified 62 eyes of 62 patients with no previous surgery in either eye that underwent IOP measurement 3-4 hours following surgery in an attempt to find and treat acute post-operative IOP elevations in eyes with glaucomatous or suspicious optic nerves. One surgeon (AW) performed combined cataract with Trabectome™ surgery (C+T group) in 31 eyes, and cataract surgery alone (C group) in the remaining 31 eyes. In the C+T and C groups, IOP before surgery was 16.2±3.6 (mean±SD, range: 8-24) mmHg and 14.6±2.7 (range: 11-22) mmHg, respectively (p=0.059). IOP was measured 3.5±0.7 (range: 2.4-5.7) hours and 3.7±0.6 (range: 2.6-5.0) hours following end of surgery, respectively (p=0.1), and it was 13.5±6.3 (range: 6-32) mmHg and 19.8±8.2 (range: 6-48) mmHg, respectively, significantly lower in the C+T group (p=0.001). IOP >21 mmHg was found in 2 (6.5%) eyes and 10 (32.3%) eyes, respectively, significantly less in the C+T group (p=0.010). Twenty hours following surgery, IOP was 12.1±5.5 (range: 5-29) mmHg and 18.0±5.5 (range: 11-32) mmHg, respectively, significantly lower in the C+T group (p=0. 0001). Compared to pre-surgery IOP, the 3-4-hour and 20-hour IOP decreased in the C+T group by 15.2±35.6% (range: (-69.5)-88.2%), and by 22.6±33.7% (range: (-72.2)-70.6%), respectively. In contrast, IOP increased in the C group by 35.2±45.3% (range: (-60.0)-150.0%) and by 24.1±38.7% (range: (-27.8)-136.4%), respectively. The difference between the groups was significant at both time points (p<0.0001). IOP change was not correlated with central corneal thickness, cataract density or phacoemulsification cumulative dissipated energy (CDE).
Compared to cataract surgery alone, combined cataract with Trabectome™ surgery may help protect eyes at risk from acute IOP elevations during the first 20 hours following surgery, even in the presence of Brimonidine 0.1% treatment.
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