EFFECT OF INTRAOCULAR LENS IMPLANTATION DURING SURGERY ON EARLY INTRAOCULAR PRESSURE CHANGES IN NUCLEUS DROP CASES

To evaluate the effect of implantation of a 3-piece foldable posterior chamber intraocular lens (IOL) into the ciliary sulcus during phacoemulsification surgery on early intraocular pressure (IOP) changes in patients with nuclear drop.

Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Ophthalmology

Twenty-two eyes of 22 patients whose surgery were complicated with nucleus drop during phacoemulsification were included in the study. 12 patients had a 3-piece posterior chamber IOL implantation simultaneously with cataract surgery (Pseudophakic group), and 10 patients were aphakic in the first session (Aphakic group). To evaluate early postoperative IOP changes, patients who underwent pars plana vitrectomy (PPV) surgery 7 days after cataract surgery were included in the study. IOP was evaluated retrospectively until the patients underwent to PPV surgery. Corneal edema with IOP of 40 mmHg and above was considered as a sudden increase in IOP and was treated with intravenous mannitol in addition to topical antiglaucoma treatment. 

Preoperative mean IOP was significantly higher in the aphakic group compared to the pseudophakic group (23.6±5.3; range 17-34 mm Hg vs. 18±4.4; range 14-26 mm Hg) (p=0.016; t-test). The rate of preoperative use of at least one antiglaucomatous drug was higher in the Aphakic group (8/10, 80% vs 3/12, 25%) (p=0.01, Chi-square test). A sudden increase in IOP was observed on the 2nd and 6th days after cataract surgery. The sudden increase in IOP was statistically significantly higher in the aphakic group compared to the pseudophakic group (6/10, 60% vs 2/12, 20%) (p=0.035).

In nucleus drop cases, 3-piece IOL implantation in the same session reduces IOP spikes and the need for preoperative antiglaucoma medication. In aphakic patients, sudden IOP elevations can be seen due to the inflammation effect of the cortex remnants that could pass into the anterior chamber due to the lack of barrier and these particles may occlude both trabeculum and the Schlemm canal. This may also affect the final visual acuity.