Preventing intraocular pressure increase after phacoemulsification and the role of perioperative apraclonidine

Abstract

Purpose To evaluate the effectiveness of prophylactic topical apraclonidine 1% in preventing an intraocular pressure (IOP) rise in the early period after uneventful phacoemulsification with intraocular lens (IOL) implantation. Setting District general hospital, United Kingdom. Methods In this prospective masked randomized trial, 61 patients had elective, routine, corneal tunnel, sutureless phacoemulsification with in-the-bag foldable IOL implantation. A single surgeon operated on all the patients. Patients were randomized to receive topical apraclonidine 1% eyedrops (n = 31) or artificial tears (control group, n = 30) 1 hour preoperatively and at the end of the surgery. An observer masked to the perioperative drops used measured the IOP preoperatively and 3 to 6 hours and 16 to 24 hours postoperatively. The primary outcome was the change in IOP between the baseline and the 2 postoperative intervals. The IOP changes within and between the groups were analyzed using the t test and chi-square test. Results The changes between the postoperative and preoperative IOPs in the study groups were statistically significant (apraclonidine, P = 0.018 and P = 0.007, respectively; artificial tears, P = 0.028 and P = 0.023, respectively; paired t test). There was no significant difference in the postoperative IOP between the apraclonidine and control groups 3 to 6 hours and 16 to 24 hours postoperatively ( P = 0.717 and P = 0.497, respectively; independent t test). The mean difference was 0.2 mm Hg (95% confidence interval [CI], −3.4 to 3.1) in the apraclonidine group and 2.2 mm Hg (95% CI, −2.5 to 7.0) in the control group. In each group, a few patients had an IOP greater than 30 mm Hg in the first 24 hours. Conclusion Prophylactic topical perioperative apraclonidine 1% did not cause a significant reduction in the postoperative IOP when compared with a control group.