title: Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension?
abstract: OBJECTIVE
  To determine whether the 1-day postoperative intraocular pressure (IOP) check following routine uncomplicated phacoemulsification is necessary in patients with pre-existing glaucoma and ocular hypertension (OHT), if acetazolamide prophylaxis is used. To investigate the practice of U.K. glaucoma specialists in IOP rise prophylaxis and follow-up regimes.
  
  
  METHODS
  The IOP 1-day postoperatively was analysed against the last recorded IOP before phacoemulsification in a cohort of patients with glaucoma or OHT who underwent uncomplicated phacoemulsification cataract surgery between December 2009 and September 2012, where it was routine practice to give acetazolamide postoperatively. U.K. and Eire Glaucoma Society members were surveyed via an online questionnaire to analyse practice among U.K. glaucoma specialists.
  
  
  RESULTS
  One hundred and seven eyes were studied: 99 with glaucoma and 8 with OHT. The mean IOP change was -0.8 mm Hg with only two eyes measuring >30 mm Hg postoperatively (2%). Both these eyes received 750 mg acetazolamide. Eighteen (17%) eyes had an IOP rise of at least 30%. In the survey of practice there were 65 respondents. Twenty-one (32%) respondents did not use IOP prophylaxis. Only 17 (26%) of respondents routinely reviewed their patients 1-day postoperatively.
  
  
  CONCLUSIONS
  Our prophylactic acetazolamide regime does not completely eliminate the risk of an IOP >30 mm Hg on day 1 post routine phacoemulsification in glaucoma/OHT patients. Patients with pre-existing glaucoma, despite acetazolamide prophylaxis, will require IOP management decisions on the first postoperative day after uncomplicated phacoemulsification surgery. U.K. expert practice is non-uniform with regard to IOP prophylaxis, and the 1-day review, and further discussion and formulation of consensus appears necessary.
authors.affiliation: Ophthalmology Department, Queen's Medical Centre, Nottingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Ophthalmology Department, Queen's Medical Centre, Nottingham, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Vernon
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage; D002386:Cataract / Q000150:complications; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000150:complications* / Q000188:drug therapy; D009885:Ophthalmology; D018918:Phacoemulsification; D011184:Postoperative Period; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013997:Time Factors; D014065:Tonometry, Ocular; D006113:United Kingdom
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide