Intraocular pressure elevation during early postoperative period after secondary intraocular lens implantation in children and adolescents

Abstract

To look at the intraocular pressure (IOP) spike in the early postoperative period after secondary intraocular lens (IOL) implantation in children. Miles Center for Pediatric Ophthalmology, Medical University of South Carolina, South Carolina, USA. Retrospective chart review. The postoperative day-1 examination of patients having secondary IOL implantation by the same surgeon was reviewed for an IOP greater than 26 mm Hg. In patients with an IOP spike, the medical history and examination findings that might be associated with the rise were evaluated. Review of 85 patient charts (133 eyes) identified 9 eyes that developed an IOP spike during the early postoperative period. Six eyes were symptomatic, with symptoms including pain, ocular discomfort, nausea, and emesis, and 6 eyes had preoperative aphakic glaucoma, which was controlled with medication. Six of 22 eyes (27%) with preoperative aphakic glaucoma and 3 of 111 eyes (3%) without glaucoma (P<.001) developed an acute IOP rise (relative risk, 10.1). The high incidence of a symptomatic early IOP spike in patients with aphakic glaucoma warrants meticulous ophthalmic viscosurgical device removal at the end of surgery, consideration of the routine use of prophylactic topical and/or systemic glaucoma medication, and monitoring during the early postoperative period.