title: Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery.
abstract: OBJECTIVE
  To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME).
  
  
  METHODS
  Ambulatory surgical center.
  
  
  METHODS
  Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approved outpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOP adjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than 15 µm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student'st-tests.
  
  
  RESULTS
  Mean minimal foveal thickness averaged 207.15 µm in the low pressure group, 205.14 µm in the normal IOP group, and 210.48 µm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating theater to 1 day after surgery was within +/-5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%).
  
  
  CONCLUSIONS
  Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improve their ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater.
  
  
  CONCLUSIONS
  Immediate postoperative IOP adjustment following cataract surgery before the patient leaves the operating theater may reduce the incidence of CME and provide patient safety and economic benefits.
authors.affiliation: Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, MO, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Jarstad
authors.affiliation: Department of Ophthalmology, SUNY-Upstate Medical University, Syracuse, NY, USA.
authors.forename: Allison R
authors.initials: AR
authors.lastname: Jarstad
authors.affiliation: Cornea and External Disease Service, Evergreen Eye Center, Federal Way, WA, USA.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Chung
authors.affiliation: Evergreen Eye Center, Federal Way, WA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Tester
authors.affiliation: Retina Service, Evergreen Eye Center, Federal Way, WA, USA.
authors.forename: Linda E
authors.initials: LE
authors.lastname: Day
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008269:Macular Edema / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D011183:Postoperative Complications; D011446:Prospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity
chemical_list: D000959:Antihypertensive Agents
keywords: CME; Cystoid; Edema; MICS; Pressure