Open Access Open Access  Restricted Access Subscription Access

Impact on Visual Outcome and Complications in Postoperative Raised Intaocular Pressure (IOP) Patients of Cataract Surgery at a Tertiary Care Hospital


Affiliations
1 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik - 422003, Maharashtra, India
 

Background and Objectives: Intraocular pressure increase frequently occurs in the early period after cataract Extraction. Some operated patients of cataract surgery, however, may experience pain, corneal oedema, glaucomatous nerve damage, or anterior ischemic optic neuropathy. Causes of this elevation in IOP include retained lens material, postoperative inflammation, and retention of viscoelastic substances within the anterior chamber. Postoperative increases in IOP are transient and benign. It is therefore important to monitor continuously the effect of new cataract surgical techniques on postoperative IOP as well as the impact of increased IOP on visual outcomes. Materials and Methods: Out of total patients who underwent cataract surgery at our institute 1311 had increase in intra-ocular pressure during November 2015 to October 2017. Out of those total number of 150 patients were selected at random after taking inclusion and exclusion criteria into consideration. Cases of increased intraocular pressure post cataract surgery were included in study were examined in full on observations documented on post-operative Day 1 then till discharge, after 7 days, 1 month and 3 months. Results: Thus, incidence of increase in intraocular pressure after cataract surgery in our institute is 24.15%. In the present study acute postoperative inflammation was the most common cause (39%) of increase in intraocular pressure. Other common causes were vitreous obstruction following posterior capsular rupture (27%), retained visco-elastic substances (22%). Least common cause (2%) in our study was retained lenticular fragments. Conclusion: Maximum patients (53%) with raised intra-ocular pressure post-cataract surgery had pressures in the range of 21 to 30 mm Hg. Majority (64%) had post-operative day 1 best corrected visual acuity between FC 1 m to 20/200. No patient had BCVA 20/20 to 20/40. Patients with increased IOP more than 40 mm Hg were associated poor visual outcome compared to patients with less IOP rise. In maximum patients (86%), intra-ocular pressure became normal (<21mm hg) within 7 days.

Keywords

Corneal Edema, Goldmann Applanation Tonometer, Intraocular pressure.
Font Size

User
Notifications

  • Gormaz A. Ocular tension after cataract surgery, Am. J. Ophthalmol. 1962; 53:832−41. https://doi.org/10.1016/0002-9394(62)93405-0.
  • Rich WJ. Intraocular pressure and wound closure after cataract extraction, Trans Ophthalmol. Soc. UK. 1968; 88:437−39.
  • Galin MA, Lin LL, Obstbaum SA. Cataract extraction and Intraocular pressure, Trans Ophthalmol. Soc. UK. 1978; 98:124−27.
  • Gross JG, Meyer DR, Robin AL, Filar AA, Kelley JS. Increased Intraocular pressure in the immediate post-operative period after extracapsular cataract extraction, Am. J. Ophthalmol. 1988; 105:466−69.
  • Kooner KS, Cooksey JC, Perry P, Zimmerman TJ. Intraocular Pressure following ECCE, phacoemulsification and PCIOL implantation, Ophthalmic. Surg. 1988; 19:643−46.
  • Tranos P, BharG, Little B. Postoperative intraocular pressure spikes: The need to treat, Eye. 2004; 18:673−79. https://doi.org/10.1038/sj.eye.6701319. PMid:15002028.
  • Ermis SS, Ozturk F, Inan UU. Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification, Eye. 2005; 19:303−07. https://doi.org/10.1038/sj.eye.6701470. PMid:15258611.
  • Hildebrand GD, Wickremasinghe SS, Tranos PG, et al. Efficacy of anterior chamber decompression in controlling early intraocular pressure spikes after uneventful phaco-emulsification, J. Cataract Refract Surg. 2003; 29:1087−92. https://doi.org/10.1016/S0886-3350(02)01891-6.
  • Percival SPB. Complications from use of sodium hyaluronate (Healonid) in anterior segment surgery, Br. J. OphthalMol. 1982; 66:714−16.
  • Passo MS, Ernest JT, Goldstick TK. Hyaluronate increases intraocular pressure when used in cataract extraction, Br. J. Ophthalmol. 1985; 69:572−75. https://doi.org/10.1136/bjo.69.8.572. PMid: 4016054, PMCid: PMC1040681.
  • Böhmer TG, Lagreze WA, Funk J. Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: E Vect of prophylactic medication, wound closure, and surgeon’s experience, Br. J. Ophthalmol. 1995; 79:809−13. https://doi.org/10.1136/bjo.79.9.809. PMid:7488598, PMCid:PMC505265.
  • Rod Foroozan MD. Cataract surgery and Intraocular pressure. http://www.medscape.com/viewarticle/571405.
  • Schwenn O, Dick HB, Krummenauer F, Krist R, Pfeiffer N. Intraocular pressure after small incision cataract surgery: Temporal sclerocorneal versus clear corneal incision, J. Cataract Refract Surg. 2001; 27:421−25. [PubMed]. https://doi.org/10.1016/S0886-3350(00)00577-0.
  • Radius RL, Maumenee AE. Visual field changes following acute elevation in intraocular pressure, Trans. Am. Acad. Ophthalmol. Otolaryngol. 1977; 83: 61−68.
  • Duke-Elder S (ed). System of Ophthalmology, Vol 11, Diseases of the lens and vitreous, Glaucoma and hypotony CV Mosby Co.: St Louis, MO, 1969, p 602.
  • Kim JY, Jo M-W, Brauner SC, Ferrufino-Ponce, Z, Ali, R, Cremers, SL and An Henderson B. Increased intraocular pressure on first postoperative day following cataract surgery, Eye London. 2011; 25(7):929−36. https://doi.org/10.1038/eye.2011.93. PMid: 21527959, PMCid: PMC3178167.
  • Tranos P, Wickremasinghe S, Hildebrand D, Asaria R, Mearza A, Nouri S et al. Same vs first postoperative day review after uncomplicated phacoemulsification. Are we overtreating early intraocular pressure spikes, J. Cataract Refract Surg. 2003; 29(3):508−12. https://doi.org/10.1016/S0886-3350(02)01649-8.

Abstract Views: 5

PDF Views: 0




  • Impact on Visual Outcome and Complications in Postoperative Raised Intaocular Pressure (IOP) Patients of Cataract Surgery at a Tertiary Care Hospital

Abstract Views: 5  |  PDF Views: 0

Authors

Saudamini Jaywantrao Jadhav
Department of Ophthalmology, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik - 422003, Maharashtra, India
Dhiraj Namdeo Balwir
Department of Ophthalmology, Dr. Vasantrao Pawar Medical College and Research Centre, Nashik - 422003, Maharashtra, India

Abstract


Background and Objectives: Intraocular pressure increase frequently occurs in the early period after cataract Extraction. Some operated patients of cataract surgery, however, may experience pain, corneal oedema, glaucomatous nerve damage, or anterior ischemic optic neuropathy. Causes of this elevation in IOP include retained lens material, postoperative inflammation, and retention of viscoelastic substances within the anterior chamber. Postoperative increases in IOP are transient and benign. It is therefore important to monitor continuously the effect of new cataract surgical techniques on postoperative IOP as well as the impact of increased IOP on visual outcomes. Materials and Methods: Out of total patients who underwent cataract surgery at our institute 1311 had increase in intra-ocular pressure during November 2015 to October 2017. Out of those total number of 150 patients were selected at random after taking inclusion and exclusion criteria into consideration. Cases of increased intraocular pressure post cataract surgery were included in study were examined in full on observations documented on post-operative Day 1 then till discharge, after 7 days, 1 month and 3 months. Results: Thus, incidence of increase in intraocular pressure after cataract surgery in our institute is 24.15%. In the present study acute postoperative inflammation was the most common cause (39%) of increase in intraocular pressure. Other common causes were vitreous obstruction following posterior capsular rupture (27%), retained visco-elastic substances (22%). Least common cause (2%) in our study was retained lenticular fragments. Conclusion: Maximum patients (53%) with raised intra-ocular pressure post-cataract surgery had pressures in the range of 21 to 30 mm Hg. Majority (64%) had post-operative day 1 best corrected visual acuity between FC 1 m to 20/200. No patient had BCVA 20/20 to 20/40. Patients with increased IOP more than 40 mm Hg were associated poor visual outcome compared to patients with less IOP rise. In maximum patients (86%), intra-ocular pressure became normal (<21mm hg) within 7 days.

Keywords


Corneal Edema, Goldmann Applanation Tonometer, Intraocular pressure.

References





DOI: https://doi.org/10.18311/mvpjms%2F2019%2Fv6i1%2F18274