Risk factors for developing intraocular pressure spikes following phacoemulsification using Healon5

1
Risk factors for developing intraocular pressure
spikes following phacoemulsification using
Healon5 in patients with and without glaucoma

• Michael W. Fung, MD
• Medical College of Virginia
• Hal Bernstein, MD
• Richmond Eye Associates

2
Purpose

• To determine risk factors for developing
  postoperative intraocular pressure spikes in
  patients undergoing phacoemulsification using
  only Healon5

3
Methods

• All surgeries performed by an experienced
  glaucoma surgeon and his fellows in a busy urban
  glaucoma practice
• All cases used solely Healon5 from start to
  finish
• IOP spike defined as IOP gt 30 on POD1

4
Results

• 256 eyes from 203 patients
• 114 Patients carried a previous diagnosis of
  glaucoma
• 37 IOP spikes occurred (of which 25 had glaucoma)

5
Results (cont)

• In single variable analysis, glaucoma status,
  preoperative IOP, and a complicated surgery
  attained statistical significance (Table 1)
• Glaucoma (OR 3.04, 95CI 1.45-6.37)
• Preoperative IOP (OR 1.19, 95CI 1.07-1.31)
• Complicated Surgery (OR 2.37, 95CI 1.14-4.97)
• However, under multivariate analysis, only
  glaucoma status and preoperative IOP maintained
  their statistical significance (Table 1)
• Glaucoma (OR 2.35, 95CI 1.08-5.13)
• Preoperative IOP (OR 1.17, 95CI 1.06-1.29)
• When examining the preoperative pressure of
  patients with and without spikes, patients who
  had IOP spikes had slightly higher pressures
  (Table 2)
• Preoperative IOP in patients with IOP spike (Mean
  17.16 with SD 4.44)
• Preoperative IOP in patients without IOP spike
  (Mean 15.07 with SD 3.10)
• t 0.009

6
Table 1. Odds Ratios for developing IOP spikes
for potential risk factors
7
Table 2. Characteristics of the 256 eyes
according to IOP spike
a t 0.30 b t 0.009 c t lt 0.0001
8
Conclusion

• Patients with preexisting glaucoma or increased
  baseline pressure were at an increased risk of
  developing an IOP spike postoperatively in our
  study population

9
References

• Oshika T, Eguchi S, Oki K, et al. Clinical
  comparison of Healon5 and Healon in
  phacoemulsification and intraocular lens
  implantation Randomized multicenter study.
  Journal of Cataract Refractive Surgery 2004,
  30(2)357-62.
• Holzer MP, Tetz MR, Auffarth GU, Welt R, Volcker
  HE. Effect of Healon5 and 4 other viscoelastic
  substances on intraocular pressure and
  endothelium after cataract surgery. Journal of
  Cataract Refractive Surgery 2001, 27(2)213-8.
• Schwenn O, Dick HB, Krummenauer F, et al.
  Healon5 versus Viscoat during cataract surgery
  intraocular pressure, laser flare, and corneal
  changes. Graefes Archive for Clinical
  Experimental Ophthalmology 2000, 238(10)861-7.
• Olivius E, Thorburn W. Intraocular pressure
  after cataract surgery with Healon. Journal
  American Intra-Ocular Implant Society 1985,
  11(5)480-2.
• Anmarkrud N, Bergaust B, Bulie T. The
  quantitative effect of Healon on early
  postoperative intraocular pressure after
  extracapsular cataract extraction with
  implantation of a posterior chamber lens. Acta
  Ophthalmologica Scandinavica 1995, 73(6)537-40.
• Zetterstrom C, Wejde G, Taube M. Healon5
  Comparison of 2 removal techniques. Journal of
  Cataract Refractive Surgery 2002, 28(9)1561-4.