Frequency of occurrence and possible causes of ophthalmic hypertension after phacoemulsification in POAG patients

PURPOSE: Retrospective analysis of intraocular pressure after phacoemulsification in POAG patients with initial medically normalized IOP. METHODS: We conducted a retrospective analysis of 60 case histories of POAG patients who underwent surgery for age-related cataract in the Scientific Research Institute of Eye Diseases during the period from 2013 to 2016 and developed a postoperative IOP elevation. The results of dynamic bidirectional pneumotonometry (Ocular Response Analyzer, USA) were used to study IOP dynamics in the operated patients. Corneal-compensated IOP parameters were analyzed. RESULTS: To identify the possible causes of postoperative ocular hypertension, patients were divided into groups depending on the course of both the operation and the postoperative period (complicated and uncomplicated), degree and duration of ocular hypertension as well as undertaken hypotensive measures. The first group included 50 patients, divided into 2 subgroups. In 30 patients (1A subgroup) I-II stage of POAG was diagnosed, and preoperative steady IOP compensation was achieved either by monotherapy with prostaglandin analogues, carbonic anhydrase inhibitors or β-blockers; or by fixed combination of drugs of the same pharmacological groups. IOPcc before the operation ranged from 11.1 to 21 mmHg with a median value of 15 mmHg. On the first day after the operation, a statistically significant increase in intraocular pressure of varying severity in patients of the first subgroup was registered, for which some patients (19 patients, 19 eyes) required an increase in local antihypertensive therapy. By the end of inpatient treatment IOPcc was normalized in all the patients, almost reaching the initial level. 1B subgroup included 20 patients with I-III stages of glaucoma, who required two or more local antihypertensive drugs for preoperative IOP normalization. Initial IOPcc values ranged from 17.7 to 24.1 mmHg with a median value of 20.8 mmHg. These patients developed a persistent increase in IOPcc after uncomplicated phacoemulsification, which required additional antihypertensive therapy. By the end of the treatment period, intraocular pressure in 9 patients was lowered to the initial values. The remaining 11 patients underwent glaucoma surgery at different times. The second group consisted of 10 patients with different stages of POAG, whose operation was complicated by postoperative inflammation and intraocular pressure decompensation. IOPcc values prior to phacoemulsification ranged from 15.5 to 19.3 mmHg with a median value of 17.2 mmHg. In the early postoperative period, these patients showed signs of inflammation of varying severity and an average IOPcc increase by 14 mmHg. In these cases we started systemic and local anti-inflammatory and dehydration therapy and increased local hypotensive regimen. With the above-listed measures, inflammatory conditions completely regressed, and intraocular pressure in these patients reached the baseline level by the end of the inpatient treatment. CONCLUSION: Glaucoma patients may present with IOP elevation in early postoperative period after uncomplicated phacoemulsification, which in most cases is transient. However, some patients may develop a persistent IOP decompensation, requiring additional antihypertensive therapy and/or glaucoma surgery. In cases of complicated phacoemulsification the severity and duration of ocular hypertension are defined, as a rule, by the rapidity of postoperative inflammation regression.

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