Skip to main content
NCBI home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1992 Sep;76(9):534–537. doi: 10.1136/bjo.76.9.534

Prevention of acute postoperative pressure rises in glaucoma patients undergoing cataract extraction with posterior chamber lens implant.

J West 1, J Burke 1, I Cunliffe 1, S Longstaff 1
PMCID: PMC504343  PMID: 1420057

Abstract

Acute elevations in intraocular pressure (IOP) commonly follow extracapsular cataract extraction and lens implant in glaucoma patients. Thirty six patients with glaucoma undergoing cataract extraction and posterior chamber lens implantation received one of three treatments. Group 1: 500 mg of Diamox Sustets (acetazolamide) 1 hour preoperatively (10 patients); Group 2: peroperative intracameral Miochol (acetylcholine) (11 patients); Group 3: the above treatments combined (15 patients). IOPs were measured at 3, 6, 9, and 24 hours postoperatively. The average of the maximum pressure rises above the preoperative level over the 24 hour period was greatest for the group receiving acetazolamide only at 8.9 mm Hg; for the acetylcholine group the average maximum rise was 6.3 mm Hg; while the combined treatment group showed a decrease of 0.7 mm Hg. IOP rises of > 6 mm Hg were seen in 7% of patients (one of 15) in the combined treatment group, 45% (five of 11) of the acetylcholine group, and 70% (seven of 10) of the acetazolamide group. IOP rises of > 10 mm Hg were seen in 7% of the combined treatment group, in 18% of the acetylcholine only group, and in 50% of the acetazolamide only group. A pressure rise > 20 mm Hg was seen in one patient receiving acetazolamide only and one patient receiving acetylcholine only. The difference between the acetylcholine group and the combined group for rises > 6 mm Hg was significant using the chi 2 test while the acetazolamide group showed a significant difference for rises > 6 and 10 mm Hg compared with the combined group. All acute pressure rises were recorded before or at 9 hours following operation except in the combined treatment patient where the rise occurred at 24 hours. To prevent the acute IOP rises seen following cataract surgery with lens implant in glaucoma patients we recommend combined ocular hypotensive therapy.

Full text

PDF
534

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Handa J., Henry J. C., Krupin T., Keates E. Extracapsular cataract extraction with posterior chamber lens implantation in patients with glaucoma. Arch Ophthalmol. 1987 Jun;105(6):765–769. doi: 10.1001/archopht.1987.01060060051031. [DOI] [PubMed] [Google Scholar]
  2. Hayreh S. S. Anterior ischemic optic neuropathy. IV. Occurrence after cataract extraction. Arch Ophthalmol. 1980 Aug;98(8):1410–1416. doi: 10.1001/archopht.1980.01020040262010. [DOI] [PubMed] [Google Scholar]
  3. Hollands R. H., Drance S. M., Schulzer M. The effect of acetylcholine on early postoperative intraocular pressure. Am J Ophthalmol. 1987 Jun 15;103(6):749–753. doi: 10.1016/s0002-9394(14)74387-9. [DOI] [PubMed] [Google Scholar]
  4. Huber C., Reme C. Lens implantation combined with trabeculectomy. Trans Ophthalmol Soc U K. 1985;104(Pt 5):574–577. [PubMed] [Google Scholar]
  5. Jay J. L. Extracapsular lens extraction and posterior chamber intraocular lens insertion combined with trabeculectomy. Br J Ophthalmol. 1985 Jul;69(7):487–490. doi: 10.1136/bjo.69.7.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kolker A. E. Visual prognosis in advanced glaucoma: a comparison of medical and surgical therapy for retention of vision in 101 eyes with advanced glaucoma. Trans Am Ophthalmol Soc. 1977;75:539–555. [PMC free article] [PubMed] [Google Scholar]
  7. Krupin T., Feitl M. E., Bishop K. I. Postoperative intraocular pressure rise in open-angle glaucoma patients after cataract or combined cataract-filtration surgery. Ophthalmology. 1989 May;96(5):579–584. doi: 10.1016/s0161-6420(89)32846-6. [DOI] [PubMed] [Google Scholar]
  8. Linn D. K., Zimmerman T. J., Nardin G. F., Yung R., Berberich S., DuBiner H., Fuqua M. Effect of intracameral carbachol on intraocular pressure after cataract extraction. Am J Ophthalmol. 1989 Feb 15;107(2):133–136. doi: 10.1016/0002-9394(89)90211-0. [DOI] [PubMed] [Google Scholar]
  9. Longstaff S., Wormald R. P., Mazover A., Hitchings R. A. Glaucoma triple procedures: efficacy of intraocular pressure control and visual outcome. Ophthalmic Surg. 1990 Nov;21(11):786–793. [PubMed] [Google Scholar]
  10. McCartney D. L., Memmen J. E., Stark W. J., Quigley H. A., Maumenee A. E., Gottsch J. D., Bernitsky D. A., Wong S. K. The efficacy and safety of combined trabeculectomy, cataract extraction, and intraocular lens implantation. Ophthalmology. 1988 Jun;95(6):754–763. doi: 10.1016/s0161-6420(88)33112-x. [DOI] [PubMed] [Google Scholar]
  11. McGuigan L. J., Gottsch J., Stark W. J., Maumenee A. E., Quigley H. A. Extracapsular cataract extraction and posterior chamber lens implantation in eyes with preexisting glaucoma. Arch Ophthalmol. 1986 Sep;104(9):1301–1308. doi: 10.1001/archopht.1986.01050210055025. [DOI] [PubMed] [Google Scholar]
  12. McMahan L. B., Monica M. L., Zimmerman T. J. Posterior chamber pseudophakes in glaucoma patients. Ophthalmic Surg. 1986 Mar;17(3):146–150. [PubMed] [Google Scholar]
  13. Obstbaum S. A. Glaucoma and intraocular lens implantation. J Cataract Refract Surg. 1986 May;12(3):257–261. doi: 10.1016/s0886-3350(86)80004-9. [DOI] [PubMed] [Google Scholar]
  14. Rich W. J., Radtke N. D., Cohan B. E. Early ocular hypertension after cataract extraction. Br J Ophthalmol. 1974 Aug;58(8):725–731. doi: 10.1136/bjo.58.8.725. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ruiz R. S., Wilson C. A., Musgrove K. H., Prager T. C. Management of increased intraocular pressure after cataract extraction. Am J Ophthalmol. 1987 Apr 15;103(4):487–491. doi: 10.1016/s0002-9394(14)74269-2. [DOI] [PubMed] [Google Scholar]
  16. Savage J. A., Thomas J. V., Belcher C. D., 3rd, Simmons R. J. Extracapsular cataract extraction and posterior chamber intraocular lens implantation in glaucomatous eyes. Ophthalmology. 1985 Nov;92(11):1506–1516. doi: 10.1016/s0161-6420(85)33828-9. [DOI] [PubMed] [Google Scholar]
  17. Simmons S. T., Litoff D., Nichols D. A., Sherwood M. B., Spaeth G. L. Extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in patients with glaucoma. Am J Ophthalmol. 1987 Nov 15;104(5):465–470. doi: 10.1016/s0002-9394(14)74102-9. [DOI] [PubMed] [Google Scholar]
  18. Thomas J. V., Simmons R. J., Belcher C. D., 3rd Argon laser trabeculoplasty in the presurgical glaucoma patient. Ophthalmology. 1982 Mar;89(3):187–197. doi: 10.1016/s0161-6420(82)34807-1. [DOI] [PubMed] [Google Scholar]
  19. Tuberville A., Nissenkorn I., Tomoda T., Wood T. O. Postsurgical intraocular pressure elevation. J Am Intraocul Implant Soc. 1983 Summer;9(3):309–312. doi: 10.1016/s0146-2776(83)80062-7. [DOI] [PubMed] [Google Scholar]
  20. Weinreb R. N., Ruderman J., Juster R., Zweig K. Immediate intraocular pressure response to argon laser trabeculoplasty. Am J Ophthalmol. 1983 Mar;95(3):279–286. doi: 10.1016/s0002-9394(14)78294-7. [DOI] [PubMed] [Google Scholar]
  21. West D. R., Lischwe T. D., Thompson V. M., Ide C. H. Comparative efficacy of the beta-blockers for the prevention of increased intraocular pressure after cataract extraction. Am J Ophthalmol. 1988 Aug 15;106(2):168–173. doi: 10.1016/0002-9394(88)90829-x. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES