![]() Rainer et al compared the effect of topical dorzolamide HCl ophthalmic solution 2% (Trusopt, Merck), a carbonic anhydrase inhibitor, with that of latanoprost ophthalmic solution 0.005% (Xalatan, Pfizer), a prostaglandin. In most cases, IOP elevation was reduced but not totally eliminated, and in other cases the elevation in IOP was only delayed. 5,7-9 However, these studies have produced conflicting results, and so there is no consensus on the efficacy of medical prophylaxis for IOP elevation. Several studies have explored the use of intracameral, topical, and systemic hypotensive agents as prophylaxis for postoperative IOP elevation. There is no standard regimen to prophylactically address elevated postoperative IOP. 5 This elevated IOP also puts patients with optic nerves already compromised by glaucoma at risk of progression. Transient postoperative IOP elevation has been reported to cause optic atrophy, anterior ischemic optic neuropathy, and vascular events such as retinal vein occlusion. 5Īlthough this transient rise in IOP is benign in most cases, for some patients it has the potential to threaten vision. 4-6 Numerous studies have documented this rise in IOP after cataract surgery, and it can be as high as 40 mm Hg in some cases. 3 The elevation in IOP typically peaks at 3 to 7 hours after cataract extraction, persists for the first 24 hours, and returns to nearly normal levels within 48 hours. After cataract extraction, any remaining OVD in either the lens capsule or the anterior chamber may obstruct trabecular outflow, resulting in elevated IOP. Retained OVD is thought to be a major contributor. 2 It occurs secondary to a combination of preexisting and iatrogenic components, which can include compromised outflow, retained OVD, surgical trauma, watertight wound closure, retained lenticular debris, release of iris pigment, hyphema, and inflammation. ELEVATED IOPĮlevated IOP is one of the most frequent complications after cataract surgery. In this article, I focus on managing a patient’s IOP after cataract surgery. Postoperative complications of cataract surgery have been well documented, and every optometrist should be prepared to manage these complications within his or her scope of practice. ![]() 1Īlthough surgical techniques can vary, understanding the basics of the surgical procedure allows ODs to better address complications associated with cataract surgery, including inflammation, refractive status, elevated or decreased IOP, infection, and posterior capsular opacification. ![]() In modern cataract surgery, a small 1.0-mm sideport incision is made, OVDs are injected to maintain space in the eye and to protect ocular structures, a 2.0-mm to 3.0-mm clear corneal incision is made for the insertion of instruments, a capsulorhexis is made, the lens is removed using phacoemulsification, and an IOL is implanted. Through advances in surgical techniques and technologies, cataract extraction has evolved from intracapsular to extracapsular cataract extraction to phacoemulsification and now laser cataract surgery. Optometrists should be prepared to discuss IOL implant options, address ocular and systemic health, and they should be comfortable managing or triaging any postoperative complication associated with cataract extraction. With a growing population in need of cataract surgery, optometry’s role in managing patients with cataracts extends far beyond simply telling them they have cataracts and referring them to an ophthalmologist colleague. If a patient’s IOP is consistently low, if he or she has a wound leak that is not resolving, or if the anterior chamber is shallow or flat, the patient should be referred back to the surgeon for consultation and possible surgical repair or revision.There is no standard regimen to address elevated postoperative IOP, but prophylaxis and sideport incision paracentesis are two commonly used approaches. ![]() Every optometrist should be prepared to manage postoperative complications of cataract surgery, including elevated and decreased IOP. ![]()
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