Incidence of Elevated Intraocular Pressure After Phacoemulsification at an Academic Institution Base

1
Incidence of Elevated Intraocular Pressure After
Phacoemulsification at an Academic Institution
Based on Quality Assurance Data

• Ly T. Nguyen, MD
• University of Colorado Health Sciences Center,
  Rocky Mountain Lions Eye Institute, Aurora, CO

2
Introduction

• Incidence of clinically significant elevated IOP
  after cataract surgery
• 2.3 to 8.91
• Factors1-3
• Retained viscoelastic agents
• Damage to trabecular meshwork
• Inflammatory debris
• Hyphema
• Pupillary block
• Peripheral anterior synechias
• Vitreous in anterior chamber

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Purpose

• To evaluate the frequency of elevated intraocular
  pressure (IOP) at 1-day post-op after
  phacoemulsification at an academic institution.

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Methods

• Retrospective review of Quality Assurance Data
  from the University of Colorado Health Sciences
  Center, Rocky Mountain Lions Eye Institute
  (Aurora, CO) between July 2002 to May 2005.
• Inclusion criteria
• All cases of phacoemulsification with intraocular
  lens implantation
• Follow-up visits POD 1, 1-2 week post-op
• Elevated IOP defined as gt23 mmHg

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Introduction

• Risk Factors
• H/o ocular hypertension
• H/o glaucoma
• H/o pseudoexfoliation

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Results

• 1559 phacoemulsification cases were performed
  from July 2002 to May 2005
• 22 cases had elevated IOP on POD 1, an incidence
  of 1.14.
• Patient Characteristics
• 11 Male, 11 Female
• Age 36-90 (avg 75 y.o)
• Patients with h/o glaucoma 2
• Patients with microvascular risk factors 72.27
  (17/22)

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Results

• Elevated IOP range on POD 1
• 23-30 mmHg 8 (36.36)
• 31-35 mmHg 6 (27.27)
• 36-40 mmHg 3 (13.63)
• gt41 mmHg 4 (18.18)
• Anterior chamber paracentesis was performed in
  50 (11/22 cases)
• 59 (13/22 cases) received pressure-lowering
  ophthalmic drops.

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Results

• Elevated IOP with Viscoelastic agents
• 95.45 with Duovisc (21/22)
• 4 with Healon-GV (1/22)
• 50 of the Duovisc group had an anterior chamber
  paracentesis for elevated intraocular pressure
  (range 32-59 mmHg).
• Possible mechanisms for elevated IOP with
  Duovisc
• Incomplete removal of viscoelastics
• Leaving eye too firm at end of case
• Plugging trabecular meshwork by lower molecular
  weight viscoelastics such as Viscoat

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Results

• 1 case of persistent elevated IOP (gt3 months) in
  a patient with h/o POAG
• No cases of post-operative secondary glaucoma
• 4 cases of intraoperative complications
• 3 cases with PC tear
• 1 case with retained lens fragment

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Conclusion

• Low incidence of elevated post-op IOP in an
  academic institution
• Higher incidence of elevated post-op IOP with the
  use of Duovisc
• Medical and surgical (paracentesis) intervention
  was necessary to control the IOP in some cases

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Contributing Authors

• Michael J. Taravella, MD
• Richard Davidson, MD
• Darren Gregory, MD
• Douglas MacKenzie, MD

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References

• 1. Browning AD et. al. Role of intraocular
  pressure measurement on the day of
  phacoemulsification cataract surgery. JCRS 2002.
  28(9) 1601-1606.
• 2. Skorkovska S et. al. Effect of viscoelastic
  substances on postoperative intraocular pressure
  in phacoemulsification. Ceska a Slovenska
  Oftalmologie 2005. 61(1)13-9.
• 3. Shingleton BJ et. al. Evaluation of
  intraocular pressure in the immediate period
  after phacoemulsification. JCRS 2001.
  27(4)524-527.