Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery
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Purpose: To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP)following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment onprevention of cystoid macular edema (CME). Setting: Ambulatory surgical center. Methods: Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approvedoutpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOPadjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherencetomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than15 μm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student’s t-tests. Results: Mean minimal foveal thickness averaged 207.15 μm in the low pressure group, 205.14 μm in the normalIOP group, and 210.48 μm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from theoperating theater to 1 day after surgery was within +/–5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHgin 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). Conclusions: Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improvetheir ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. Synopsis: Immediate postoperative IOP adjustment following cataract surgery before the patient leaves the operatingtheater may reduce the incidence of CME and provide patient safety and economic benefits.
Abstract
Purpose: To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP)following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment onprevention of cystoid macular edema (CME). Setting: Ambulatory surgical center. Methods: Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed in a Medicare approvedoutpatient ambulatory surgery center. Surgical parameters included a keratome incision of 1.5 mm to 2.8mm, topical anesthetic, case completion IOP estimation by palpation and patient visualization of light, and IOPadjustment before exiting the operating theater. IOPs were classified into three groups: low (<16 mmHg), normal (16to 21 mmHg), and elevated (>21 to 30 mmHg). IOP measurements were repeated 1 day after surgery. Optical coherencetomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal thickness greater than15 μm was used to indicate CME. Statistical analysis was performed using one- and two-tailed Student’s t-tests. Results: Mean minimal foveal thickness averaged 207.15 μm in the low pressure group, 205.14 μm in the normalIOP group, and 210.48 μm in the elevated IOP group 2 weeks following surgery. CME occurred in 14 of 170eyes (8.2%) at 2 weeks (low IOP, 35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from theoperating theater to 1 day after surgery was within +/–5 mmHg in 54 eyes (31.7%), elevated by 6 to 15 mmHgin 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes (2.3%). IOP was reduced by 6 mmHg to 15mmHg in 39 eyes (22.9%) and reduced by more than 15 mmHg in nine eyes (5.3%). Conclusions: Immediate postoperative adjustment of IOP may prevent CME in MICS. Physicians can improvetheir ability to estimate postoperative IOP with experience in tonometry to verify immediate postoperative IOP. There are patient safety and economic benefits to immediate IOP adjustment in the operating theater. Synopsis: Immediate postoperative IOP adjustment following cataract surgery before the patient leaves the operatingtheater may reduce the incidence of CME and provide patient safety and economic benefits.
참고문헌 (22)
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