High IOP a risk factor for IOP spikes after cataract surgery

PARIS — Patients with higher preoperative IOP may be at risk of developing IOP spikes hours after cataract surgery, said a surgeon speaking here. In addition, patients with existing glaucoma may also be at risk for IOP spikes after cataract surgery, the surgeon said.

Paul O’Brien, MD, reported his findings in 51 patients with a mean age of 75 who underwent routine phacoemulsification under topical anesthesia. He spoke on the topic here at the European Society of Cataract and Refractive Surgeons meeting.

IOP was measured preoperatively and re-evaluated at 2 to 3 hours and again at 24 hours after surgery. The mean preop IOP was 14.5 mm Hg; this rose to 22 mm Hg at the first follow-up and fell to 17 mm Hg at 24 hours after surgery. Mean nuclear density of the patients was 6.1. Ten patients had an IOP over 30 mm Hg at the 2-to-3-hour mark, Dr. O’Brien said.

The patients who did not experience a postop spike in IOP averaged 75.3 years old, Dr. O’Brien said.

“Fifteen percent had glaucoma before undergoing phaco and had an average of 13.9 mm Hg IOP preoperatively,” he said. “Those who experienced a spike 2 to 3 hours after phaco were on average 74.7 years old, and 30% had glaucoma preoperatively. Their mean preop IOP was 16.8 mm Hg,” he said.

Nuclear density, absolute phaco time and patient age were not predictive factors, he said. “It’s extremely difficult to predict who will experience a postop IOP spike,” he said. He advised surgeons to “maybe give a prophylactic or an antiglaucoma medication before surgery” to patients who have a higher preop IOP or glaucoma.