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Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification Cataract Surgery.

Abstract To determine the accuracy of visual estimation of immediate postoperative intraocular pressure (IOP) following microincision cataract surgery (MICS) and the effect of immediate postoperative IOP adjustment on prevention of cystoid macular edema (CME).
PMID
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Authors

Mayor MeshTerms

Postoperative Complications

Keywords

CME

Cystoid

Edema

MICS

Pressure

Journal Title korean journal of ophthalmology : kjo
Publication Year Start




PMID- 28243022
OWN - NLM
STAT- MEDLINE
DA  - 20170228
DCOM- 20170314
LR  - 20170314
IS  - 2092-9382 (Electronic)
IS  - 1011-8942 (Linking)
VI  - 31
IP  - 1
DP  - 2017 Feb
TI  - Immediate Postoperative Intraocular Pressure Adjustment Reduces Risk of Cystoid
      Macular Edema after Uncomplicated Micro Incision Coaxial Phacoemulsification
      Cataract Surgery.
PG  - 39-43
LID - 10.3341/kjo.2017.31.1.39 [doi]
AB  - PURPOSE: To determine the accuracy of visual estimation of immediate
      postoperative intraocular pressure (IOP) following microincision cataract surgery
      (MICS) and the effect of immediate postoperative IOP adjustment on prevention of 
      cystoid macular edema (CME). SETTING: Ambulatory surgical center. METHODS:
      Prospective, randomized analysis of 170 eyes in 135 patients with MICS, performed
      in a Medicare approved outpatient ambulatory surgery center. Surgical parameters 
      included a keratome incision of 1.5 mm to 2.8 mm, topical anesthetic, case
      completion IOP estimation by palpation and patient visualization of light, and
      IOP adjustment before exiting the operating theater. IOPs were classified into
      three groups: low (<16 mmHg), normal (16 to 21 mmHg), and elevated (>21 to 30
      mmHg). IOP measurements were repeated 1 day after surgery. Optical coherence
      tomography (Stratus OCT, Zeiss) was measured at 2 weeks. An increase in foveal
      thickness greater than 15 microm was used to indicate CME. Statistical analysis
      was performed using one- and two-tailed Student's t-tests. RESULTS: Mean minimal 
      foveal thickness averaged 207.15 microm in the low pressure group, 205.14 microm 
      in the normal IOP group, and 210.48 microm in the elevated IOP group 2 weeks
      following surgery. CME occurred in 14 of 170 eyes (8.2%) at 2 weeks (low IOP,
      35.7%; normal IOP, 14.2%; elevated IOP, 50.0%). Change in IOP from the operating 
      theater to 1 day after surgery was within +/-5 mmHg in 54 eyes (31.7%), elevated 
      by 6 to 15 mmHg in 22 eyes (12.9%), and elevated more than 15 mmHg in four eyes
      (2.3%). IOP was reduced by 6 mmHg to 15 mmHg in 39 eyes (22.9%) and reduced by
      more than 15 mmHg in nine eyes (5.3%). CONCLUSIONS: Immediate postoperative
      adjustment of IOP may prevent CME in MICS. Physicians can improve their ability
      to estimate postoperative IOP with experience in tonometry to verify immediate
      postoperative IOP. There are patient safety and economic benefits to immediate
      IOP adjustment in the operating theater. SYNOPSIS: Immediate postoperative IOP
      adjustment following cataract surgery before the patient leaves the operating
      theater may reduce the incidence of CME and provide patient safety and economic
      benefits.
FAU - Jarstad, John S
AU  - Jarstad JS
AD  - Department of Ophthalmology, Mason Eye Institute, University of Missouri School
      of Medicine, Columbia, MO, USA.
FAU - Jarstad, Allison R
AU  - Jarstad AR
AD  - Department of Ophthalmology, SUNY-Upstate Medical University, Syracuse, NY, USA.
FAU - Chung, Gary W
AU  - Chung GW
AD  - Cornea and External Disease Service, Evergreen Eye Center, Federal Way, WA, USA.
FAU - Tester, Robert A
AU  - Tester RA
AD  - Evergreen Eye Center, Federal Way, WA, USA.
FAU - Day, Linda E
AU  - Day LE
AD  - Retina Service, Evergreen Eye Center, Federal Way, WA, USA.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20170202
PL  - Korea (South)
TA  - Korean J Ophthalmol
JT  - Korean journal of ophthalmology : KJO
JID - 8804513
RN  - 0 (Antihypertensive Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antihypertensive Agents/*therapeutic use
MH  - Female
MH  - Humans
MH  - Intraocular Pressure/*physiology
MH  - Macular Edema/diagnosis/etiology/*prevention & control
MH  - Male
MH  - Microsurgery
MH  - Middle Aged
MH  - Phacoemulsification/*adverse effects
MH  - *Postoperative Complications
MH  - Prospective Studies
MH  - Tomography, Optical Coherence/*methods
MH  - Visual Acuity
PMC - PMC5327173
OTO - NOTNLM
OT  - *CME
OT  - *Cystoid
OT  - *Edema
OT  - *MICS
OT  - *Pressure
COI - Conflict of Interest: No potential conflict of interest relevant to this article 
      was reported.
EDAT- 2017/03/01 06:00
MHDA- 2017/03/16 06:00
CRDT- 2017/03/01 06:00
PHST- 2015/11/10 [received]
PHST- 2015/12/21 [accepted]
AID - 10.3341/kjo.2017.31.1.39 [doi]
PST - ppublish
SO  - Korean J Ophthalmol. 2017 Feb;31(1):39-43. doi: 10.3341/kjo.2017.31.1.39. Epub
      2017 Feb 2.

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