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Oral acetazolamide reduces IOP elevation during, after cataract surgery
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Oral acetazolamide given 1 hour prior to cataract surgery in eyes with glaucoma significantly reduces the IOP elevation from 1 to 24 hours, while administering the drug 3 hours postoperatively reduced IOP elevation at 5 hours or more postoperatively, according to researchers.
The prospective, randomized clinical study took place at the Hayashi Eye Hospital in Fukuoka, Japan. Consecutive eyes with medically-controlled primary open-angle glaucoma that were scheduled for phacoemulsification with IOL implantation were recruited.
A total of 90 patients were assigned randomly to one of three groups the day before surgery: eyes that were to undergo oral acetazolamide administration 1 hour prior to surgery, eyes that were to undergo oral acetazolamide administration 3 hours after surgery, or eyes that were not to undergo administration.
Age gender, ratio of left to right eyes, corneal astigmatism, manifest spherical equivalent value, nuclear opalescence, duration of surgery and total volume of irrigating solution used did not differ significantly among the groups. There were 44 men and 46 women.
Mean IOP 1 hour preoperatively and at the end of surgery did not differ significantly among groups, according to researchers.
A significantly elevated mean IOP was found from 3 to 7 hours postoperatively and then decreased at 24 hours in all groups. Mean IOP was significantly lower in the group receiving oral acetazolamide preoperatively than in the two other groups at 1 and 3 hours postoperatively (P .0031). IOP was significantly lower in both the preoperative and postoperative administration groups than in the nonadministration group at 5, 7, and 24 hours postoperatively (P .0224), according to the study.
Oral acetazolamide administration 1 hour preoperatively significantly reduced the IOP elevation from 1 to 24 hours, while administration 3 hours postoperatively reduced the IOP elevation at 5 hours of more after surgery, the researchers said. –by Abigail Sutton
Disclosure: Hayashi reported financial support from Alcon Japan Ltd., Santen Pharmaceutical Inc., Wakamoto Pharmaceutical Ltd. and Bayer Yahuhin Ltd. Please see the full study for all remaining authors’ financial disclosures.
Perspective
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Scott Anthony, OD, FAAO
Care coordination for cataract surgery in our glaucoma patients may require advance planning to consider adjuvant glaucoma surgery as well as ensuring perioperative intraocular pressure control to minimize potential adverse effects that could hasten progression. Therefore, when referring patients for cataract surgery it is imperative that optometrists accurately convey to the surgeon the patient’s disease severity, IOP control, status of progression and any prior adverse effects to glaucoma medications.
In patients with mild open-angle glaucoma with controlled IOP, it may not be necessary to consider prophylactic IOP-lowering medications other than their current glaucoma drop regimen. Conversely, a patient with advanced glaucoma and borderline IOP control may require a more careful approach.
This study provides evidence for an effective way to prevent post-cataract surgery IOP spike. It is up to the referring optometrists to provide an accurate clinical picture to the surgeon to facilitate perioperative decisions that could influence the outcome for our patients. In speaking with ophthalmology colleagues, cataract surgery IOP spikes can prove to be the tipping point in susceptible glaucoma patients.
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