Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeon's experience.
OBJECTIVE
A prospective clinical trial was carried out to evaluate the effect of prophylactic medication, the technique of wound closure, and the surgeon's experience on the intraocular pressure rise after cataract extraction.


METHODS
In 100 eyes, the intraocular pressure was measured before as well as 2-4, 5-7, and 22-24 hours after phacoemulsification and posterior chamber lens implantation. Each of 25 patients received either 1% topical apraclonidine, 0.5% topical levobunolol, 500 mg oral acetazolamide, or placebo. Forty four eyes were operated with sclerocorneal sutureless tunnel and 56 eyes with corneoscleral incision and suture. Sixty three operations were performed by experienced surgeons (more than 300 intraocular operations) and 37 by inexperienced surgeons (less than 200 intraocular operations).


RESULTS
The pressure increase from baseline to the maximum 5-7 hours after surgery did not differ significantly (p = 0.8499) for apraclonidine (9.5 mm Hg), levobunolol (7.2 mm Hg), acetazolamide (7.8 mm Hg), and placebo (8.6 mm Hg). The increase was significantly (p = 0.0095) lower in eyes with corneoscleral tunnel (5.5 mm Hg) than in eyes with corneoscleral suture (10.5 mm Hg) and significantly (p = 0.0156) lower for experienced (6.6 mm Hg) than for inexperienced surgeons (11.2 mm Hg).


CONCLUSIONS
The intraocular pressure rise after phacoemulsification and posterior chamber lens implantation depends strongly on the technique of wound closure and the surgeon's experience. Compared with these two factors, the effect of prophylactic medication can be neglected.
D000086:Acetazolamide / Q000627:therapeutic use*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D002040:Levobunolol / Q000627:therapeutic use*; D008297:Male; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000517:prevention & control*; D011364:Professional Practice; D011446:Prospective Studies; D014945:Wound Healing
D000317:Adrenergic alpha-Antagonists; C016986:apraclonidine; D002040:Levobunolol; D003000:Clonidine; D000086:Acetazolamide