Katarakt Cerrahisini Takiben Erken Dönemde Göz İçi Basınç Değişiklikleri

Abstract

Amaç: Katarakt cerrahisi sonrası göz içi basıncı (GİB) ve merkezi kornea kalınlığı (MKK) değişimlerini incelemek.

Gereç ve Yöntem: Çalışmaya senil kataraktı bulunan 62 hastanın 62 gözü dahil edildi. Tüm hastalar komplike olmamış fakoemülsifikasyon ve göz içi lensi (GİL) implantasyonu içeren katarakt cerrahisi geçirdiler. GİB, nonkontakt tonometre ile katarakt ameliyatından önce ve sonrasında 3. saatte, 1. günde, 1. haftada, 2. haftada ve 1. ayda ölçüldü. GİB ve MKK ölçümleri tekrarlanan ölçümler için varyans analizleri (ANOVA) ile test edildi.

Bulgular: Çalışmaya ortalama yaşları 66±12.38 (40-84) olan 62 hasta dahil edildi. Hastaların 35'i kadın (% 56.5), 27'si (% 43.5) erkekti. Preoperatif ortalama MKK 535,69 µ idi. Preoperatif ortalama GİB 14.63 (10-21) mmHg idi. GİB, 3. saatte 19,95 (9-58), 1. günde 14.50 (8-29), 1. haftada 12.83 (8-19), 2. haftada 12.91 (7-18), 1. ayda 12.72 (8-18) idi. Preoperatif GİB 14.63 mmHg iken 3. saatte istatiksel anlamlı olarak 19,95 mmHg'ya (%26) yükseldi (p<0.001). 1. günde ise istatiksel olarak anlamlı şekilde 14.5 mmHg'ye düştü (p<0.05). Preoperatif ve postoperatif 1. gün arasında istatiksel olarak anlamlı fark yoktu (p>0.05). 1. gün ve 1. hafta arasında 1.67 mmHg düşüş görüldü. Bu fark istatiksel olarak anlamlı idi (p<0.05). Gözlerin 7'sinde ciddi derecede GİB yüksekliği mevcuttu (>30 mmHg). Bu gözlerde herhangi bir tedaviye gerek duyulmadan GİB normale döndü.

Sonuç: Katarakt cerrahisi sonrası ilk saatlerde anlamlı şekilde GİB yükselmekte. 1. günde ise normale dönmektedir. GİB'teki yükselmeler sağlıklı gözlerde muhtemelen zararsızdır, fakat riskli optik diskli hastalarda geçici yükselmeler dahi zararlı olabilir. Risk altındaki hastalarda GİB yükselmesi için gerekli önlemler alınmalıdır. 

Keywords

• Fakoemülsifikasyon,Göz içi basıncı,Merkezi kornea kalınlığı

Intraocular Pressure Changes In Early Period Following Cataract Surgery

Abstract

Objective: To analyze the changes of intraocular pressure (IOP) and central corneal thickness (CCT) after cataract surgery.

Material and Method: The study was composed of 62 eyes of 62 patients with senile cataract. All the patients had undergone uncomplicated phacoemulsification surgery and intraocular lens implantation. IOP was measured by non-contact tonometer at baseline before cataract surgery and on follow-upvisits 3 hours, 1 day, 1,2 and 4 weeks afterward. IOP and CCT measurements were analyzed by analysis of variance (ANOVA) for repeated measure.

Results: The study was composed of 62 patients with a mean age of 66±12.38 (range, 40 to 84) years. There were 35 females (56.5%) and 27 males (43.5%). The mean CCT was 535,69 before cataract surgery.The pre-operative mean IOP was 14.63 (10-21) mmHg at baseline visit. IOP was 19,95 (9-58) at the third hours, 14.50 (8-29) at the first day, 12.83 (8- 19) at the first week, 12.91 (7-18) at the second week, 12.72 (8-18) at the first month. The mean preoperative IOP was 14.63 mmHg, which statistical significant increased to 19,95 mmHg (26%) on the 3rd hours (p<0,001). The IOP decreased significantly to 14.5 mmHg at 1st day (p<0.05). The difference in IOP between pre-operative and post-operative first day visit was no significantly different (p>0.05). The decrease in mean IOP between the postoperative first day and the first week was 1.67 mmHg. This difference was significantly different (p<0.05). Seven of eyes in this study had a considerable elevation (>30 mmHg) in the pressure after the surgery. IOP was returned to normal values without antiglaucomatous medication in these eyes.

Conclusion: The IOP increase significantly in the first hours following cataract surgery. It is returned to normal values in the first day of surgery. It appears that IOP increasing in healthy eyes are probably harmless, but the similar transient elevation of IOP may be detrimental in cases with compromised optic discs. Necesarry measures should be taken to increase IOP in patients at risk.  

Keywords

• Central corneal thickness,Intraocular pressure,Phacoemulsification

References

1. 1- Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol. 2010;21:20-24.
2. 2- Hildebrand GD, Wickremasinghe SS, Tranos PG, Harris ML, Little BC. Efficacy of anterior chamber in controlling early intraocular pressure spikes after uneventful phacoemulsification. J Cataract Refract Surg 2003;19:1087-1092.
3. 3- Ermis SS, Ozturk F, Inan UU. Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification. Eye 2005;19:303-307.
4. 4- Kurt E, Mayalı H. Early Post-Operative Complications in Cataract Surgery. In: Farhan Zaidi (Eds.), Cataract Surgery, InTech Open 2013;245-258.
5. 5- Unal M, Yücel I. Effect of bimatoprost on intraocular pressure after cataract surgery. Can Journal of Ophthalmol 2008:43;712-716.6- Bomer TG, Lagreze W-DA, Funk J. Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: effect of prophylactic medication, wound closure, and surgeon’s experience. Bri Journal of Ophthalmol 1995:79;809-813.
6. 7- Tanaka T, Inoue H, Kudo S, Ogawa T. Relationship between postoperative intraocular pressure elevation and residual sodium hyaluronate following phacoemulsification and aspiration. . J Cataract Refract Surg 1997:23;284-288.
7. 8- Lewis RA. What is the best way to prevent and manage postoperative intraocular pressure spikes? In: Chang DF (ed). Curbside Consultation in Cataract Surgery. Thorofare, NJ, Slack, 2007; 187-189.
8. 9- Tranos P, Wickremasinghe S, Hildebrand D, Asaria R, Mearza A, Nouri S et al. Same vs first postoperative day review after uncomplicated phacoemulsification. Are we overtreating early intraocular pressure spikes? J Cataract Refract Surg 2003; 29(3): 508–512.

9. 10- Ahmed IK, Kranemann C, Chipman M, Malam F. Revisiting early postoperative follow-up after phacoemulsification. J Cataract Refract Surg 2002; 28(1): 100–108.
10. 11- Koçak A, Anayol MA, Yülek F, Şimşek Ş. Topikal Dorzolamidin Fakoemülsifikasyon Cerrahisi Sonrasında Göz İçi Basınç Üzerine Etkinliği. Glo-Kat 2006;1:123-126.
11. 12- 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;33:1941-5.
12. 13- Shingleton BJ, Gamell LS, O’Donoghue MW, Baylus SL, King R. Long-term changes in intraocular pressure after clear corneal phacoemulsification: Normal patients versus glaucoma suspects and glaucoma patients. J Cataract Refract Surg 1999:25;885-890.
13. 14- Poley BJ, Lindstrom RL, Samuelson TW, Schulze R. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes Evaluation of a causal relationship between the natural lens and open-angle glaucoma: J Cataract Refract Surg 2009:35;1946-1955.
14. 15- Kim KS, Kim JM, Park KH, Choi CY, Chang HR. The effect of cataract surgery on diurnal intraocular pressure fluctuation. J Glaucoma. 2009;18:399-402.
15. 16- Issa SA, Pacheco J, Mahmood U, Nolan J, Beatty S.. A novel index for predicting intraocular pressure reduction following cataract surgery. Br J Ophthalmol. 2005;89:543-6.
16. 17- Tranos P, Bhar G, Little B. Postoperative intraocular pressure spikes: the need to treat. Eye 2004:18;673-679.
17. 18- Kasetti SR, Desai SP, Sivakumar S Sunderraj P. Preventing intraocular pressure increase after phacoemulsification and the role of perioperative apraclonidine. J Cataract Refract Surg 2002;28:2177-2180.
18. 19- Alagöz G, Kükner Ş, Serin D, Çelebi S, Yalçın A. Katarakt Cerrahisinde Viskoelastik Maddeye Bağlı Yükselen Göz İçi Basıncının Düşürülmesinde Korneal İnsizyon Bölgesinden Viskoz Ön Kamara Mayisi Boşaltılmasının Etkinliği. Fırat Tıp Dergisi 2007;12(1): 44-47.
19. 20- Behndig A, Lundberg B. Transient corneal edema after phacoemulsification: Comparison of 3 viscoelastic regimens. J Cataract Refract Surg 2002;28:1551–6.
20. 21- Singh R, Vasavada AR, Janaswamy G. Phacoemulsification of brunescent and black cataracts. J Cataract Refract Surg 2001;27:1762–9.