Early Intra Ocular Pressure Spikes After Uneventful Phacoemulsification: Incidence And Risk Factors

To evaluate the incidence of early postoperative intraocular pressure ( IOP) elevation following uneventful phacoemulsification and to identify preoperative and intraoperative risk factors associated with early IOP spikes.

Tertiary Care Ophthalmology Institute 

A retrospective analysis was performed on consecutive patients who underwent uneventful phacoemulsification with intraocular lens implantation by a single surgeon. Patients with intraocular complications were excluded. Preoperative data included age, baseline IOP, axial length, presence of glaucoma, and pseudoexfoliation syndrome. Intraoperative variables included phacoemulsification time, cumulative dissipated energy ( CDE), and type of ophthalmic viscoelstic device (OVD) used. Postoperatively IOP was measured on day 1 and 1 week.  An early IOP spike was defined as IOP >=25mmHg on first operative day. Multivariate regression analysis was performed to identify risk factors associated with early IOP elevation.

A total of 518 eyes of 480 patients were included in the study. The mean preoperative IOP was 16.9+_3.2 mmHg. Early postoperative IOP spikes occured in 38 eyes ( 7.33%) on postoperative day 1. Eyes with pre-existing glaucoma demonstrated a significantly higher incidence of IOP elevation compared with non-glaucomatous eyes ( 14.4% vs 6.3%). Pseudoexfoliation syndrome was also associated with increased risk of early IOP spike (p<0.05). Increased CDE and longer phaco time were also associated with higher risk of early postoperative IOP elevation.  Sodium hyaluronate (OVD) use was associated with least risk of IOP spike  . By 1 week, IOP returned to near baseline levels in 95% of the eyes with short-term topical anti-glaucoma medication. 

Early postoperative IOP elevation following phacoemulsification can occur after unevenful cataract surgery but is usually transient. Patients with preexisting glaucoma , pseudoexfoliation or prolonged surgery are at greater risk. Use of Sodium hyaluronate OVD is associated with lower risk of IOP spike. It is important to identify eyes at risk of possible IOP spike preoperatively and ensure meticulous surgery with use of sodium hyauronate OVD and  measure IOP in all patients postoperatively to identify the IOP spike and treat it appropriately.