Tip of the Month
Publishing date: February 2020
The Science behind the Tip
IOP spikes, i.e. an IOP elevation after surgery compared to baseline, often occur in eyes with glaucoma.2 IOP spikes may lead to further progression of glaucomatous damage.http://3-6 Prior studies assessed the prophylactic effect of oral acetazolamide. In a recently published randomized trial eyes with medically well-controlled primary open-angle and pseudoexfoliative glaucoma which were scheduled for phacoemulsification were assigned to receive the following topical hypotensive medications immediately after surgery: (1) prostaglandin (travoprost 0.004%, Travatanz; Novartis Pharma K.K., Tokyo, Japan), (2) beta blocker (timolol maleate 0.5%, Timoptol; Santen Pharmaceutical, Tokyo, Japan), or (3) carbonic anhydrase inhibitor (brinzolamide, Azopt; Novartis Pharma K.K.).http://7 All antihypertensive topical medications were discontinued the day before surgery and one of the previous mentioned medications was applied immediately after surgery. Mean IOP increased significantly between 4 and 8 hours postoperatively and then decreased at 24 hours postoperatively. Mean IOP increased significantly between 4 and 8 hours postoperatively and then decreased at 24 hours postoperatively in all groups (P < .0001). Mean IOP was significantly lower in the brinzolamide group. Given the results, topical brinzolamide may be beneficial to prevent IOP spikes in eyes with glaucoma after cataract surgery.
Contributor: Marc Töteberg-Harms, Zurich
1. Levkovitch-Verbin H, Habot-Wilner Z, Burla N, Melamed S, Goldenfeld M, Bar-Sela SM, Sachs D. Intraocular pressure elevation within the first 24 hours after cataract surgery in patients with glaucoma or exfoliation syndrome. Ophthalmology. 2008 Jan;115(1):104-8. Epub 2007 Jun 11. PubMed PMID: 17561259.
2. Barak A, Desatnik H, Ma-Naim T, Ashkenasi I, Neufeld A, Melamed S. Early postoperative intraocular pressure pattern in glaucomatous and nonglaucomatous patients. J Cataract Refract Surg. 1996 Jun;22(5):607-11. PubMed PMID: 8784635.
3. Slabaugh MA, Bojikian KD, Moore DB, Chen PP. Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients. J Cataract Refract Surg2014;40(4):538–544.
4. Hayashi K, Yoshida M, Manabe SI, Yoshimura K. Prophylactic effect of oral acetazolamide against intraocular pressure elevation after cataract surgery in eyes with glaucoma. Ophthalmology 2017;124(5):701–708.
5. Hayashi K, Yoshida M, Sato T, Manabe SI, Yoshimura K. Intraocular pressure elevation after cataract surgery and its prevention by oral acetazolamide in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 2018;44(2):175–181.
6. Ahmed II, Kranemann C, Chipman M, Malam F. Revisiting early postoperative follow-up after phacoemulsification. J Cataract Refract Surg 2002;28(1):100–108.
7. Hayashi K, Yoshida M, Sato T, Manabe SI. Effect of Topical Hypotensive Medications for Preventing Intraocular Pressure Increase after Cataract Surgery in Eyes with Glaucoma. Am JOphthalmol. 2019 Sep;205:91-98. doi: 10.1016/j.ajo.2019.03.012. Epub 2019 Mar 20. PubMed PMID: 30902694.
Tip Reviewer: Roger Hitchings
Tip Editors: Frances Meier-Gibbons, Humma Shahid, Karl Mercieca, Francisco Goni