Document Detail


Intraocular pressure elevation within the first 24 hours after cataract surgery in patients with glaucoma or exfoliation syndrome.
MedLine Citation:
PMID:  17561259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To investigate whether eyes with glaucoma or exfoliation syndrome without glaucoma are prone to exhibit intraocular pressure (IOP) elevation shortly after cataract surgery and, if so, whether timolol maleate 0.5% reduces these spikes. DESIGN: Prospective randomized double-masked clinical trial. PARTICIPANTS: One hundred twenty-two patients with normal eyes, medically well-controlled glaucoma, or exfoliation syndrome who underwent uneventful phacoemulsification cataract extraction. METHODS: Patients were randomly assigned to an immediately postoperative drop of either timolol maleate 0.5% or no treatment. Intraocular pressure was measured preoperatively and 4, 8, and 24 hours and 1 week later. MAIN OUTCOME MEASURES: Intraocular pressure measurements. RESULTS: The changes in postoperative IOP over time differed significantly between glaucoma, exfoliation syndrome, and normal (P = 0.005). Intraocular pressure was significantly lower in the normal group (n = 25) than in both the glaucoma (n = 18) and exfoliation syndrome (n = 19) groups (P<0.001). With 1 drop of prophylactic timolol maleate 0.5% at completion of surgery, the normal group (n = 25) again had IOP significantly lower than those of the glaucoma (n = 15) and exfoliation syndrome (n = 20) groups (P<0.001). Treatment with timolol maleate 0.5% significantly changed postoperative IOP over time in the glaucomatous eyes (P = 0.003), but it made no difference in the exfoliation syndrome (P = 0.4) or normal (P = 0.5) eyes. Intraocular pressure > 25 mmHg did not occur among normal eyes. Intraocular pressure > 25 mmHg and > 30 mmHg occurred in 10 (55%) and 5 (28%) glaucoma patients, respectively, and 5 (27%) and 2 (11%) exfoliation syndrome patients, respectively. Timolol maleate 0.5% eliminated IOP spikes > 30 mmHg and reduced the frequency of IOP > 25 mmHg in both groups to 14% in the glaucoma group and 5% in the exfoliation syndrome group. Most IOP elevation occurred at 4 hours postoperatively. The mean IOP was <20 mmHg in all groups 1 day postoperatively. CONCLUSIONS: Medically well-controlled glaucoma patients and patients with exfoliation syndrome may experience IOP elevation shortly after cataract surgery. Instillation of timolol maleate 0.5% at the end of the procedure in this series eliminated IOP > 30 mmHg, but IOP elevation below that level can still occur.
Authors:
Hani Levkovitch-Verbin; Zohar Habot-Wilner; Nirit Burla; Shlomo Melamed; Modi Goldenfeld; Shai M Bar-Sela; Dan Sachs
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2007-06-11
Journal Detail:
Title:  Ophthalmology     Volume:  115     ISSN:  1549-4713     ISO Abbreviation:  Ophthalmology     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-01     Completed Date:  2008-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802443     Medline TA:  Ophthalmology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  104-8     Citation Subset:  IM    
Affiliation:
Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel. halevko@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Antihypertensive Agents / administration & dosage
Circadian Rhythm
Double-Blind Method
Exfoliation Syndrome / complications*
Female
Glaucoma, Open-Angle / complications*
Humans
Intraocular Pressure*
Male
Ocular Hypertension / drug therapy,  etiology*
Ophthalmic Solutions / administration & dosage
Phacoemulsification*
Postoperative Complications*
Prospective Studies
Timolol / administration & dosage
Tonometry, Ocular
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Ophthalmic Solutions; 26839-75-8/Timolol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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