Neodymium:yttrium-aluminum-garnet capsulotomy and intraocular pressure in pseudophakic patients with glaucoma.
OBJECTIVE
To determine the 1- and 3-hour changes in intraocular pressure after neodymium:yttrium-aluminum-garnet (Nd:YAG) capsulotomy in pseudophakic patients with glaucoma and to determine the effect of acetazolamide and apraclonidine on these changes.


METHODS
Randomized controlled trial.


METHODS
Pseudophakic patients with glaucoma requiring Nd:YAG posterior capsulotomy (n = 76).


METHODS
Patients undergoing Nd:YAG posterior capsulotomy were randomly allocated to receive no therapy, oral acetazolamide (250 mg), or topical apraclonidine 1% within 1 hour before capsulotomy.


METHODS
Intraocular pressures 1 and 3 hours after laser therapy were recorded.


RESULTS
Data were available for 76 eyes in 76 patients. Twenty-nine patients received no therapy; 24, oral acetazolamide; and 23, apraclonidine. One fifth (6/29) of patients with glaucoma developed a pressure rise of > or =5 mmHg if untreated, and 3% (1/29) developed a pressure rise of >10 mmHg. In comparison, no patients in the acetazolamide group developed a pressure rise of > or =5 mmHg (P = 0.02), and 1 of 24 in the apraclonidine group (P = 0.08) developed such a pressure rise, with none developing a pressure rise of >10 mmHg. When comparing all treated with nontreated, a reduction in the proportion with pressure rise was found (P = 0.01). All of the patients who developed a pressure rise of > or =5 mmHg did so within the first hour.


CONCLUSIONS
In the absence of therapy, clinically significant post-Nd:YAG pressure rises occur in one fifth of patients with glaucoma undergoing capsulotomy. Oral acetazolamide and topical apraclonidine reduce the frequency and magnitude of pressure rises and are of comparable effectiveness. In this study, all clinically important pressure rises developed within the first hour.
Barnes
Eric A
EA
Moorfields Eye Hospital, London, United Kingdom.
Murdoch
Ian E
IE
Subramaniam
Srinivasan
S
Cahill
Angela
A
Kehoe
Brenda
B
Behrend
Michael
M
D000086:Acetazolamide / Q000627:therapeutic use; D000284:Administration, Oral; D000287:Administration, Topical; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use; D003000:Clonidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005901:Glaucoma / Q000150:complications*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D053685:Laser Therapy; D007903:Lens Capsule, Crystalline / Q000601:surgery*; D018918:Phacoemulsification; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D019591:Pseudophakia / Q000150:complications*
D000316:Adrenergic alpha-Agonists; D000959:Antihypertensive Agents; D002257:Carbonic Anhydrase Inhibitors; C016986:apraclonidine; D003000:Clonidine; D000086:Acetazolamide