The Risk Factors Influencing Early Transient Intraocular Pressure Spikes Following Cataract Surgery In Eyes With Open-Angle Glaucoma

This retrospective study aimed to identify risk factors associated with early transient intraocular pressure (IOP) spikes in open-angle glaucoma (OAG) eyes following cataract surgery.

Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital

Forty-nine eyes of 49 OAG patients (68.8±9.3 years) with well-controlled IOP by glaucoma medications undergoing cataract surgery were included. Exclusion criteria were prior glaucoma surgery or uveitis. The study assessed differences between pre- and 16-20 hours post-operative (op) IOPs, and IOP spikes (the increase of ≥10 mmHg). Multiple regression analysis was utilized to evaluate the influence on the IOP change by parameters, which included age, gender, central corneal thickness (CCT), anterior chamber depth (ACD), axial length (AL), preoperative IOP, medication score, glaucoma treatment duration, mean deviation (MD) of static visual field, surgical time, cumulative dissipated energy (CDE) of phacoemulsification, and irrigation volume.

The pre-op IOP was 13.6±2.6 [range: 6.0-18.0] mmHg and the post-op IOP was 18.5±6.7 [9.0-40.0] mmHg, with a change of 4.9±6.4 [-5.0 - 24.0] mmHg. IOP spikes occurred in 24.5 % of eyes. Various parameters to impact IOL changes were as follows: CCT: 527.5±31.3μm, ACD:3.2±0.4mm, AL:25.8±2.0mm, glaucoma medication score: 2.0±1.1, glaucoma treatment duration: 5.4±5.0 years, MD: -7.4±5.9dB. Surgical parameters were as follows, surgical time: 11.2±4.6 minutes, CDE: 5.5±4.8, and irrigation volume: 52.5±21.0ml. Multiple regression analysis indicated a significant correlation between IOP change and glaucoma medication score as well as IOP change and irrigation volume (P=0.001 and 0.005, β=0.44 and 0.39, R²=0.27).

In OAG eyes, pre-op glaucoma medication score and irrigation volume were identified as significant risk factors for early transient IOP spikes following cataract surgery.