Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients.
OBJECTIVE
To evaluate the risk factors for and frequency of an acute intraocular pressure (IOP) elevation (spike) after phacoemulsification in patients with glaucoma.


METHODS
Academic glaucoma clinics and operating rooms.


METHODS
Retrospective case series.


METHODS
Charts of consecutive glaucoma patients without previous incisional glaucoma surgery having phacoemulsification by the same surgeon between August 1996 and July 2012 were reviewed to obtain demographic information, preoperative glaucoma medications, severity and treatment measures, intraoperative course, and postoperative outcomes. A postoperative IOP spike was defined as IOP greater than 50% above baseline IOP. Main outcome measures were the number of eyes with a postoperative IOP spike and risk factors associated with an IOP spike after phacoemulsification.


RESULTS
Of 271 eyes (271 patients) included in the study, 45 (17%) had an IOP spike. Risk factors for postoperative IOP spike by multivariate analysis included longer axial length (AL) or associated characteristics (wider angle grade on gonioscopy, deeper anterior chamber, and male sex), higher number of preoperative IOP-lowering medications, previous laser trabeculoplasty, and lack of postoperative oral acetazolamide. One eye (0.4%) required trabeculectomy during the 90-day postoperative period.


CONCLUSIONS
A significant proportion of glaucoma patients having phacoemulsification had an IOP spike. Patients requiring a higher number of IOP-lowering medications or laser trabeculoplasty for IOP control preoperatively and those with a greater AL should be treated more aggressively with IOP-lowering medication in the immediate postoperative period.


BACKGROUND
No author has a financial or proprietary interest in any material or method mentioned.
From the Department of Ophthalmology (Slabaugh, Bojikian, Moore, Chen), University of Washington, Seattle, Washington; the Department of Ophthalmology (Bojikian), Federal University of São Paulo, São Paulo, Brazil. Electronic address: mas12@uw.edu.
Mark A
MA
Slabaugh
From the Department of Ophthalmology (Slabaugh, Bojikian, Moore, Chen), University of Washington, Seattle, Washington; the Department of Ophthalmology (Bojikian), Federal University of São Paulo, São Paulo, Brazil.
Karine D
KD
Bojikian
From the Department of Ophthalmology (Slabaugh, Bojikian, Moore, Chen), University of Washington, Seattle, Washington; the Department of Ophthalmology (Bojikian), Federal University of São Paulo, São Paulo, Brazil.
Daniel B
DB
Moore
From the Department of Ophthalmology (Slabaugh, Bojikian, Moore, Chen), University of Washington, Seattle, Washington; the Department of Ophthalmology (Bojikian), Federal University of São Paulo, São Paulo, Brazil.
Philip P
PP
Chen
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000209:etiology*; D018918:Phacoemulsification; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D014792:Visual Acuity
D000959:Antihypertensive Agents