Effect of Various Ocular Hypotensive Drugs on 3- and 24-Hour Post-Cataract Surgery IOP
Narrative Responses:
Purpose
Immediate post cataract surgery IOP spikes are common. They can cause discomfort, and may endanger a glaucomatous optic nerve. This study was done to determine the comparative effectiveness of presently available ocular hypotensive drugs in blunting post cataract surgery IOP spikes.
Methods
All ocular hypotensive drugs presently available in the US were included. 840 routine cataract surgeries, randomized. One surgeon (LLF).Randomization was done by mixing slips of paper in a bag and drawing one out for each patient, assigning the drug. Exclusions were glaucoma, on meds, asthma, any surgical complication, and patient not wishing to participate or not available to return for exam at 24 hours. Pressures were measured by Goldmann Applanation by Ophthalmologist, Optometrist, or experienced Tech. B+L Stelaris, 2.0mm "Wong" Incision. Viscoelastic Amvisc. IOL was Akreos in 3/4, AcrySof Toric in 1/4 of cases.
Results
Pressure lowering, in order of effectiveness, was: Cosopt, Combigan, Timoptic 0.5%, Pilocarpine 4%, Pilocarpine 2%, Trusopt, Dorzolamide,Azopt, Alphagan, Brimonidine, Pilocarpine 4%, Pilocarpine 2%,Diamox 250mg, two tabs, Diamox 500mg Sequel, Betoptic-S, Lumigan, Control (Tears). The Simbrinza Study is not yet completed, and some patients for the Comprehensive study have not yet been added, but these results will be in and evaluated well before meeting time.
Conclusion
Immediate post-operative pressure spikes are common after routine cataract surgery (25% in these studies). Non-Selective Beta Blockers work best to prevent these. Topical CAIs are as good, or better, than systemic. Generic drops studied worked as well as brand name Lumigan and Betoptic-S are no better than control.