IOP MONITORING PREOPERATIVELY AND POST OPERATIVELY – OUR OBSERVATIONS AT DR. P.S.R. GOVERNMENT REGIONAL EYE HOSPITAL, KURNOOL MEDICAL COLLEGE, KURNOOL

Main Article Content

Dr. P.A.S. Chalapathy Reddy
Dr. P.R. Siva Sankar
Dr. Konanki Rajesh Venkatesh

Keywords

Topical corticosteroids, Intraocular pressure, post-operative inflammation

Abstract

Background: Cataract is major cause of blindness and morbidity worldwide, with treatment of choice being cataract surgery.  Postoperative inflammation is the major problem after cataract surgery, managed by administration of topical corticosteroid drops. Most common side effect of topical corticosteroid is increase in intraocular pressure.


Objective: of our study is to observe the Intraocular pressure changes after cataract surgery and on administration of topical corticosteroid drops.


Methods:200 patients who underwent uneventful small incision cataract surgery and phacoemulsification were put on fix drug combination of 0.3% Gatifloxacin and 0.1% Dexamethasone sodium phosphate. Intraocular pressure (IOP) monitored using non-contact tonometer at preoperatively and compared with 1st day, 1st week, 2nd week, 4th week and 6th week postoperatively.


Results: The final mean IOP was calculated and compared with each other, showed rise in mean IOP postoperatively at 4th week i.e. 23.5 mm hg, 8.27 mmhg higher than mean IOP preoperatively (15.25 mmhg ) and second highest at first week postoperatively i.e. 21.23mmhg , 5.98 mmhg higher than baseline preoperative IOP


Conclusion: Steroid-induced IOP elevation was observed mostly after 4 weeks of topical steroid therapy. The prevalence of steroid responders is relatively significant in our study sample, being 9%; thus coming to a conclusion that topical steroid should be used judiciously. Topical steroids should be tapered early & can be replaced / supplemented with topical NSAIDS and lubricant eye drops.

Abstract 107 | pdf Downloads 64

References

1. Ishii K, Kabata T, Oshika T (2008). The impact of cataract surgery on cognitive impairment and depressive mental status in elderly patients. Am J Ophthalmol 146:404-42409.
2. Chang MA, Congdon NG, Baker SK, Bloem MW, Savage H, Et al. (2008).The surgical management of cataract: Barriers, Best practices and outcomes. Int Ophthalmol 28:247-260
3. Baltussen R Sylla M, Mariotti S, Cost effectiveness analysis of cataract surgery: A global and regional analysis, Bull world health organ, 2004; 82;338-45.
4. Rai zaman M, Donnenfeld E, Weinstein A, clinical comparision of two topical Prednisolone acetate 1% formulations in reducing inflammation after cataract surgery, Curr Med Res Opin,2007;23:2325-31
5. Sheppard JD, Comstock TL, Cavet ME. Impact of the Topical Ophthalmic Corticosteroid Loteprednol Etabonate on Intraocular Pressure. Adv Ther. 2016 Apr;33(4):532-52.
6. Wei M, Chen LM, Huang ZY, Zhang GW, Guan HJ, Ji M. Expression profile analysis to identify potential gene changes induced by dexamethasone in the trabecular meshwork. Int J Ophthalmol. 2022;15(8):1240-1248.
7. Mohd Nasir NA, Agarwal R, Krasilnikova A, Sheikh Abdul Kadir SH, Iezhitsa I. Effect of dexamethasone on the expression of MMPs, adenosine A1 receptors and NFKB by human trabecular meshwork cells. J Basic Clin Physiol Pharmacol. 2020 Jul 22;31(6)
8. MF Armaly Statistical attributes of the steroid hypertensive response in the clinically normal eye .1:The demonstration of three levels of responseInvest Ophthalmol1965418797
9. B Becker Intraocular pressure response to topical corticosteroidsInvest Ophthalmol19654198205
10. Y Kusne P Kang R Fintelmann A retrospective analysis of intraocular pressure changes after cataract surgery with the use of prednisolone acetate 1% versus difluprednate 0.05%Clin Ophthalmol20161023293610.2147/opth.s121849
11. Duong HQ, Westfield KC, Singleton IC, Comparing Three Post-Op Regiments for Management of Inflammation Post Uncomplicated Cataract Surgery. ‘Are Steroids Really Necessary?’. J Clin Exp Ophthalmol, 2011;2:163.