Purpose: To evaluate short-term intraocular pressure (IOP) changes after phacoemulsification in glaucoma and normal patients and the effect of oral acetazolamide (Diamox) to control IOP in these patients. Methods: 120 patients undergoing cataract surgery were included in this prospective multicenter study involving 6 University Eye Clinics: 60 patients with well-controlled primary open-angle glaucoma (POAG) and 60 controls. Half of the study participants received oral acetazolamide, 250 mg, 1 and 6 h after surgery. The treated and untreated groups were matched for age and density of cataract. All patients underwent a standard phacoemulsification procedure and were checked for IOP with Goldmann tonometry in the morning before surgery and then at 3, 6, 21 and 24 h postoperatively by a masked evaluator. Results: The group with POAG showed a significant postsurgical increase in IOP (p < 0.001) at all time points. Six of thirty (20%) untreated POAG patients showed at least 1 IOP reading above 30 mm Hg whereas acetazolamide significantly reduced postoperative IOP at all time points (p < 0.01) and in no case was IOP >30 mm Hg. The control group had high IOP during the first 6 h (p < 0.01), but normal values thereafter. Conclusion: A significant short-term IOP increase may be found after phacoemulsification both in POAG and normal patients; this is not dangerous in normal subjects, but can be potentially dangerous in POAG patients. The use of systemic acetazolamide provided significant control of IOP and could be considered a ‘possible standard’ management of cataract surgery in POAG patients.

1.
Damji KF, Konstas AG, Liebmann JM, et al: Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol 2006;90:1014–1018.
2.
Mathalone N, Hyams M, Neiman S, et al: Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients. J Cataract Refract Surg 2005;31:479–483.
3.
Acton J, Salmon JF, Scholtz R: Extracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucoma. J Cataract Refract Surg 1997;23:930–934.
4.
Ahmed II, Kranemann C, Chipman M, Malam F: Revisiting early postoperative follow-up after phacoemulsification. J Cataract Refract Surg 2002;28:100–108.
5.
Levkovitch-Verbin H, Habot-Wilner Z, Burla N, et al: Intraocular pressure elevation within the first 24 hours after cataract surgery in patients with glaucoma or exfoliation syndrome. Ophthalmology 2008;115:104–108.
6.
Yasutani H, Hayashi K, Hayashi H, Hayashi F: Intraocular pressure rise after phacoemulsification surgery in glaucoma patients. J Cataract Refract Surg 2004;30:1219–1224.
7.
Hirneiss C, Neubauer AS, Kampik A, Schönfeld CL: Comparison of prednisolone 1%, rimexolone 1% and ketorolac tromethamine 0.5% after cataract extraction: a prospective, randomized, double-masked study. Graefes Arch Clin Exp Ophthalmol 2005;243:768–773.
8.
Almond MC, Wu MC, Chen PP: Pigment dispersion and chronic intraocular pressure elevation after sulcus placement of 3-piece acrylic intraocular lens. J Cataract Refract Surg 2009;35:2164–2166.
9.
Moser CL, Martin-Baranera M, Garat M, de Miguel PV, Rubio M: Corneal edema and intraocular pressure after cataract surgery: randomized comparison of Healon5 and Amvisc Plus. J Cataract Refract Surg 2004;30:2359–2365.
10.
Rainer G, Menapace R, Findl O, et al: Intraocular pressure rise after small incision cataract surgery: a randomised intraindividual comparison of two dispersive viscoelastic agents. Br J Ophthalmol 2001;85:139–142.
11.
Rainer G, Menapace R, Schmid KE, et al: Natural course of intraocular pressure after cataract surgery with sodium chondroitin sulfate 4%-sodium hyaluronate 3% (Viscoat). Ophthalmology 2005;112:1714–1718.
12.
Schaal S, Barr CC: Management of retained lens fragments after cataract surgery with and without pars plana vitrectomy. J Cataract Refract Surg 2009;35:863–867.
13.
Zamvar U, Dhillon B: Postoperative IOP prophylaxis practice following uncomplicated cataract surgery: a UK-wide consultant survey. BMC Ophthalmol 2005;5:24.
14.
Ritch R: The Glaucomas. Mosby, London, 1995.
15.
Borazan M, Karalezli A, Akman A, Akova YA: Effect of antiglaucoma agents on postoperative intraocular pressure after cataract surgery with Viscoat. J Cataract Refract Surg 2007;33:1941–1945.
16.
Cetinkaya A, Akman A, Akova YA: Effect of topical brinzolamide 1% and brimonidine 0.2% on intraocular pressure after phacoemulsification. J Cataract Refract Surg 2004;30:1736–1741.
17.
Dayanir V, Ozcura F, Kir E, et al: Medical control of intraocular pressure after phacoemulsification. J Cataract Refract Surg 2005;31:484–488.
18.
Katsimpris JM, Siganos D, Konstas AG, Kozobolis V, Georgiadis N: Efficacy of brimonidine 0.2% in controlling acute postoperative intraocular pressure elevation after phacoemulsification. J Cataract Refract Surg 2003;29:2288–2294.
19.
Kir E, Cakmak H, Dayanir V: Medical control of intraocular pressure with brinzolamide 1% after phacoemulsification. Can J Ophthalmol 2008;43:559–562.
20.
Age-Related Eye Disease Study Research Group. The age-related eye disease study (AREDS) system for classifying cataracts from photographs: AREDS report No 4. Am J Ophthalmol 2001;131:167–175.
21.
Brusini P, Filacorda S: Enhanced Glaucoma Staging System (GSS 2) for classifying functional damage in glaucoma. J Glaucoma 2006;15:40–46.
22.
Drolsum L, Haaskjold E, Davanger M: Results and complications after extracapsular cataract extraction in eyes with pseudoexfoliation syndrome. Acta Ophthalmol (Copenh) 1993;71:771–776.
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