J Korean Ophthalmol Soc.  2014 Nov;55(11):1659-1668. 10.3341/jkos.2014.55.11.1659.

Risk Factors for Early Postoperative Intraocular Pressure Elevation after Phacoemulsification in Trabeculectomized Eyes

• Gu WM
• Lim SH
• Cha SC

• KMID: 2216615
• DOI: http://doi.org/10.3341/jkos.2014.55.11.1659

Abstract

PURPOSE
In this study, we investigated the frequency and risk factors for early postoperative intraocular pressure (IOP) elevation after phacoemulsification in patients with a prior trabeculectomy.
METHODS
We performed a retrospective chart review of 200 eyes (172 patients, study group) with filtering bleb after previous trabeculectomy and 207 eyes (144 patients, control group) without previous trabeculectomy, who underwent temporal clear corneal phacoemulsification with posterior chamber lens implantation. Twelve possible risk factors including age, gender, glaucoma type, interval from trabeculectomy to phacoemulsification, axial length, preoperative IOP, preoperative bleb morphology (height, vascularity), glaucoma medication, and concomitant intraoperative procedures (iris manipulation, anterior vitrectomy, subconjunctival mitomycin C injection) were analyzed to identify independent risk factors using a multivariate logistic regression method. Early postoperative IOP elevation was defined as IOP value > or = 25 mm Hg or an IOP increase > or = 10 mm Hg the morning after surgery compared to the preoperative IOP.
RESULTS
There was a significant difference in the frequency of IOP elevation between the study group (25 eyes, 12.5%) and control group (6 eyes, 2.9%; p < 0.001). The mean early postoperative IOP (15.2 +/- 6.7 mm Hg) was significantly higher than preoperative IOP (12.5 +/- 4.4 mm Hg) in the study group (p < 0.001). Risk factors for early postoperative IOP elevation were low bleb height (odds ratio; OR = 9.995, p = 0.003) and iris manipulation (OR = 4.831, p = 0.026) in the study group while risk factors were preoperative use of glaucoma medication (OR = 3.492, p = 0.004) and iris manipulation (OR = 34.249, p = 0.009) in the control group.
CONCLUSIONS
Phacoemulsification increases the risk of IOP spike in prior trabeculectomized eyes, especially those with low bleb height and intraoperative iris manipulation. We suggest intraoperative and postoperative efforts to minimize intraocular inflammation and earlier follow-up examination in these patients.

Keyword

Glaucoma; Intraocular pressure; Phacoemulsification; Risk factor; Trabeculectomy

MeSH Terms

Blister
Follow-Up Studies
Glaucoma
Humans
Inflammation
Intraocular Pressure*
Iris
Logistic Models
Mitomycin
Phacoemulsification*
Retrospective Studies
Risk Factors*
Trabeculectomy
Vitrectomy
Mitomycin

Figure

• 

  Figure 1. Standard photos of bleb height (A-C) and vascularity (D-F) from modified Indiana Bleb Grading System. (A) Elevated bleb. (B) Moderate elevated bleb. (C) Low elevated bleb. (D) Avascular bleb. (E) Hypovascular bleb. (F) Vascular bleb.

• 

  Figure 2. Mean intraocular pressure (IOP) in trabeculectomized group over a 12-month period. Group A (IOP spike group) tended to be worse than group B (no IOP spike group) in long-term IOP control. Values are presented as mean± SD. ∗Repeated measures ANOVA and Bonferroni post hoc analysis for multiple comparisons.

Reference

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