[Increased intraocular pressure after cataract extraction--effect of surgical technique, surgical procedure and preventive drug administration. A prospective, randomized double-blind study].
BACKGROUND
We performed a double-masked, randomized and prospective study to compare the effect of surgical technique, surgeon's experience, and prophylactic medication on the intraocular pressure rise after cataract extraction.


METHODS
Intraocular pressure of 120 patients was measured the day before, as well as two to four, five to seven and 22 to 24 hours after uncomplicated cataract extraction. 47 patients were operated with phacoemulsification and sclerocorneal sutureless tunnel (phaco/tunnel). 61 patients with phacoemulsification and corneoscleral incision and suture (phaco/suture), and 12 patients with extracapsular technique (ECCE). 48 operations were done by inexperienced surgeons (less than 200 intraocular operations), 72 by experienced surgeons (300-2000 intraocular operations). Patients were treated with either levobunolol, acetazolamide, apraclonidine, or placebo. Each treatment group contained 30 patients.


RESULTS
In all groups, the mean intraocular pressure increased to a maximum at five to seven hours after surgery. The pressure rise was significantly higher in the ECCE group (20.6 mm Hg) than in the phaco/suture group (10.5 mm Hg) and in the phaco/tunnel group (5.4 mm Hg, p always < 0.05). Eyes operated by inexperienced surgeons had a significantly (p < 0.005) greater pressure rise (12.9 mm Hg) than eyes operated by experienced surgeons (7.1 mm Hg). Treatment had no significant (p = 0.41) effect on the intraocular pressure rise.


CONCLUSIONS
The intraocular pressure rise after cataract extraction strongly depends on the surgical technique and to a lesser extent, on the surgeon's experience. At least for phacoemulsification, the effect of the prophylactic medication used in this study is small and appears to be clinically irrelevant.
Bömer
T G
TG
Universitäts-Augenklinik Freiburg.
Lagrèze
W D
WD
Funk
J
J
D000086:Acetazolamide / Q000008:administration & dosage*; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods*; D002983:Clinical Competence; D003000:Clonidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D007910:Lenses, Intraocular; D002040:Levobunolol / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000209:etiology / Q000517:prevention & control*; D009883:Ophthalmic Solutions; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies
D000316:Adrenergic alpha-Agonists; D009883:Ophthalmic Solutions; C016986:apraclonidine; D002040:Levobunolol; D003000:Clonidine; D000086:Acetazolamide
Intrakularer Druckanstieg nach Kataraktextraktion--Einfluss von Operationstechnik, Operationserfahrung und medikamentöser Prophylaxe. Eine prospektive, randomisierte Doppelblindstudie.