Effect of Differing Ocular Hypotensive Drops Immediately After Cataract Surgery on 3- and 24-Hour Postop IOP

Monday, April 20, 2015: 3:36 PM
Room 1B (San Diego Convention Center)
Luther L. Fry, MD
Eric L. Fry, MD
E. Randy Craven, MD, FACS

To compare the effectiveness of all currently available ocular hypotensive drugs in keeping IOP down in the first 24 hours after cataract surgery, and blunting immediate postoperative IOP spikes.

All surgeries were by the same surgeon (LLF). At completion of surgery, an envelope was opened, randomizing the patient to their drug, or placebo (artificial tears).  This drop was placed before the speculum and drape were removed.  Pressures were checked with Goldmann Applanation by an experienced technician 3 hours post-op.  The 24 hour pressure was checked by an experienced technician, or an Optometrist, mostly by goldmann applanation. Pressures above 20 received dorzolamide, timolol 0.5%, and Brinzolamide drops and re-checked in 45 minutes.  Pressures above 35 received a side port burp, then the above mentioned drops and re-check in 45 minutes. Exclusions were:  Glaucoma, asthma, surgical complication, missed visit, or not wishing to participate. We will present a meta-analysis of multiple similar studies over the past 2 years, approximately 1000 patients.

Preliminary results of this study were presented at ASCRS in Boston 2014.  The completed study will be presented this year. Effectiveness, from best (lowest pressures) to worst (highest pressures): Cosopt, Combigan, Simbrinza, Timolol 0.5%, Brimonidine, Alphagan, Dorzolamide, Pilocarpine 2%, Trusopt, Pilocarpine 4%, Azopt, Betoptic-S, Artificial tears, Lumigan, Diamox 250 mg X2, Diamox 500 mg Sequel X1. Each line is best to worst, but the drugs in each line were not much different.

Cosopt BEST, Combigan, Simbrinza, and Timolol 0.5% next. SUPRISES: Pilo 2% and 4% minimally better than control (Probably Blocked by Midriacyl); Lumigan NO better than control (Probably takes a couple of weeks); Systemic CAI no better than topical CAI (!); Generics as good, or better, than brand name. SO, we now use: Generic Cosopt for Non-Asthmatics; Simbrinza for Asthmatics; and NO Systemic CAIs (If no better, why put up with systemic side effects).