Intraocular Pressure Elevation After Cataract Surgery: Results of Residents and Senior Staff at Henry Ford Health System
Narrative Responses:
Purpose
To determine the incidence of IOP elevation on postoperative day 1 (POD#1) following cataract surgery by either residents or senior staff for the sake of direct comparison and to examine the influence of associated variables on the incidence of postoperative IOP elevation.
Methods
Retrospective review of 2472 consecutive 2.2-2.8mm temporal clear corneal cataract extractions by phacoemulsification performed by either residents or senior staff at HFHS. Fellow eyes were excluded resulting in 1847 eyes. IOP measurements of >40mmHg, >30mmHg and >23mmHg were examined along with incremental IOP elevations of ≥ 20mmHg and 10mmHg relative to preoperative/baseline IOP. Associated variables included: Age, Gender, Diabetes, Hypertension, Glaucoma, Glaucoma Suspicion, Uveitis, and Vitreous Loss. Logistic regression analysis of the data was performed using a Wald Chi-Square test.
Results
>40mmHg: Overall 1%, Residents 3.7%, Staff 0.7%. Odds ratio (OR): Glaucoma 4.4(p=0.006), trauma 10.3(p=0.003), vitreous loss 12.4(p<0.001), resident 5.8(p<0.001)
>30mmHg: Overall 4.7%, Residents 10.1%, Staff 4.0%. OR: Glaucoma 3.0(p<0.001), trauma 5.7(p<0.001), vitreous loss 7.4(p<0.001), resident 2.7(p<0.001)
>23mmHg: Overall 14.6%, Residents 23.3%, Staff 13.6%. OR: Glaucoma 2.3(p<0.001), trauma 3.0 (p=0.01), vitreous loss 3.6(p<0.001), resident 1.9(p<0.001)
≥ 20mmHg from baseline: Overall 1.7%, Residents 4.8%, Staff 1.4%. OR: Glaucoma 2.8(p=0.002), trauma 8.8(p<0.001), vitreous loss 9.1(p<0.001), resident 3.6(p=0.002)
≥ 10mmHg from baseline: Overall 10.9%, Residents 20.6%, Staff 9.8%. OR: Glaucoma 2.0(p<0.001), trauma 2.8(p=0.03), vitreous loss 4.5(p<0.001), resident 2.4(p<0.001)
Conclusion
The resident incidence at HFHS (23.3%) was similar to the previously determined incidence. Residents have 2-5 times the incidence of POD#1 IOP elevation and variables such as gender, trauma, vitreous loss, Glaucoma, Glaucoma Suspicion are also significant contributors. Consideration for prophylactic IOP lowering is advised in high risk patients.