Postoperative IOP prophylaxis practice following uncomplicated cataract surgery: a UK-wide consultant survey

Springer Science and Business Media LLC - 2005
Usha Zamvar1, Baljean Dhillon2
1Department of Ophthalmology, Stirling Royal Infirmary, Livilands, Stirling, UK
2Princess Alexandra Eye Pavilion, Edinburgh, UK

Tóm tắt

In order to minimise postoperative intraocular pressure (IOP) rise, after routine uncomplicated cataract surgery, prophylaxis may be adopted. Currently, there are no specific guidelines in this regard resulting in wide variation in practice across the UK. We sought to document these variations through a questionnaire survey. A questionnaire was sent to all consultant ophthalmic surgeons in the UK. 62.6% of surgeons did not use any IOP lowering agents. 37.4% surgeons routinely prescribed some form of medication. The majority (86.8%) used oral diamox. 20.6% of surgeons said they based their practice on evidence, 43.3% on personal experience, and 17.6% on unit policy. Surprisingly, among the two groups of surgeons (those who gave routine prophylaxis, and those who did not) the percentages of surgeons quoting personal experience, unit policy, or presence of evidence was strikingly similar. The timing of the first postoperative IOP check varied from the same day to beyond 2 weeks. Only 20.2% of surgeons had ever seen an adverse event related to IOP rise; this complication is thus very rare. This survey highlights a wide variation in the practice and postoperative management of phacoemulsification cataract surgery. What is very striking is that there is a similar proportion of surgeons in the diametrically opposite groups (those who give or do not give routine IOP lowering prophylaxis) who believe that there practice is evidence based. The merits of this study suggests that consideration must be given to drafting a uniform guideline in this area of practice.

Từ khóa


Tài liệu tham khảo

Tan JH, Newman DK, Klunker C, Watts SE, Burton RL: Phacoemulsification cataract surgery: is routine review necessary on the first postoperative day?. Eye. 2000, 14: 53-5.

Tufail A, Foss AJ, Hamilton AM: Is the first day postoperative review necessary after cataract extraction?. Br J Ophthalmol. 1995, 79: 646-8.

Whitefield L, Crowston J, Little BC: First day follow up for routine phacoemulsification?. Br J Ophthalmol. 1996, 80: 148-50.

Cohen VM, Demetria H, Jordan K, Lamb RJ, Vivian AJ: First day postoperative review following uncomplicated phacoemulsification. Eye. 1998, 12: 634-6.

Dinakara S, Desai SP, Raj PS: Is the first postoperative day review necessary following uncomplicated phacoemulsification surgery?. Eye. 2000, 14: 364-6.

Desai P, Minassian DC, Reidy A: National cataract surgery survey 1997–98: a report of the results of the clinical outcomes. Br J Ophthalmol. 1999, 83: 1336-40.

Zohdy GA, Rogers ZA, Lukaris A, Sells M, Roberts-Harry TJ: A comparison of the effectiveness of dorzolamide and acetazolamide in preventing postoperative intraocular pressure rise following phacoemulsification surgery. J R Coll Surg Edinb. 1998, 43: 344-6.

Araie M, Ishi K: Effects of apraclonidine on intraocular pressure and blood-aqueous barrier permeability after phacoemulsification and intraocular lens implantation. Am J Ophthalmol. 1993, 116: 67-71.

Fry LL: Comparison of the postoperative intraocular pressure with Betagan Betoptic, Timoptic, Iopidine, Diamox, Pilopine Gel, and Miostat. J Cataract Refract Surg. 1992, 18: 14-9.

Scherer WJ, Mielke DL, Tidwell PE, Hauber FA: Effect of Latanoprost on intraocular pressure following cataract extraction. J Cataract Refract Surg. 1998, 24: 964-7.

Barak A, Desatnik H, Ma-Naim T, Ashkenazi I, Neufeld A, Melamed S: Early postoperative intraocular pressure pattern in glaucomatous and non glaucomatous patients. J Cataract Refract Surg. 1996, 22: 607-11.

Bomer TG, Lagreze WD, Funk J: Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeons' experience. Br J Ophthalmol. 1995, 79: 809-13.

Rainer G, Menapace R, Schmetterer K, Findl O, Georgopoulos M, Vass C: Effect of Dorzolamide and latanoprost on intraocular pressure after small incision cataract surgery. J Cataract Refract Surg. 1999, 25: 1624-9. 10.1016/S0886-3350(99)00260-6.

Sterk CC, Renzenbrink-Bubberman AC, van Best JA: The effect of 1% apraclonidine on intraocular pressure after cataract surgery. Ophthalmic Surg Lasers. 1998, 29: 472-5.

Ruiz RS, Wilson CA, Musgrove KH, Prager TC: Management of intraocular pressure after cataract extraction. Am J Ophthalmol. 1987, 103: 487-91.

Byrd S, Singh K: Medical control of intraocular pressure after cataract surgery. J Cataract Refract Surg. 1998, 24: 1493-7.

Lai JS, Chua JK, Leung AT, Lam DS: Latanoprost versus timolol gel to prevent ocular hypertension after phacoemulsification and intraocular lens implantation. J Cataract Refract Surg. 2000, 26: 386-91. 10.1016/S0886-3350(99)00364-8.

Duperre J, Grenier B, Lemire J, Mihalovits H, Sebag M, Lambert J: Effect of timolol vs acetazolamide on sodium hyaluronate-induced rise in intraocular pressure after cataract surgery. Can J Ophthalmol. 1994, 29: 182-6.

Tinley CG, Frost A, Hakin KN, McDermott W, Ewings P: Is visual outcome compromised when next day review is omitted after phacoemulsification surgery? A randomised controlled trial. Br J Ophthalmol. 2003, 87: 1350-5. 10.1136/bjo.87.11.1350.

Thirumalai B, Baranyovits PR: Intraocular pressure changes and the implications on patient review after phacoemulsification. J Cataract Refract Surg. 2003, 29: 504-7. 10.1016/S0886-3350(02)01481-5.

Fraunfelder FT, Meyer SM, Bagby GC, Dreis MW: Hematologic reactions to carbonic anhydrase inhibitors. Am J Ophthalmol. 1985, 100: 79-81.

Doust J, Del Mar C: Why do doctors use treatments that do not work?. BMJ. 2004, 328: 474-5. 10.1136/bmj.328.7438.474.

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2415/5/24/prepub

Thông tin
Thông tin xuất bản

Springer Science and Business Media LLC

Thông tin tác giả