Medical control of intraocular pressure after phacoemulsification

Prophylaxis against intraocular pressure spikes following uncomplicated phacoemulsification: a systematic-review and meta-analysis

BACKGROUND

To investigate the effect of perioperative intraocular pressure (IOP) lowering medications on controlling postoperative IOP following uncomplicated phacoemulsification.

METHODS

Ovid MEDLINE, EMBASE, and Cochrane CENTRAL databases were searched up until November 2022. Randomised controlled trials (RCTs) that assessed IOP change via applanation tonometry in medicated and control arms following uncomplicated cataract surgery in healthy eyes were included. The primary outcome was the weighted mean difference (WMD) of IOP at 2-8 h, 12-24 h, and 1-7 days postoperatively within each medication class or common fixed-combination formulations. Risk of bias was assessed using the revised risk of bias in randomised trials (RoB-2). Level of evidence was rated using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) RESULTS: From 702 screened articles, 30 RCTs involving 2986 eyes were included. There was a statistically significant reduction in IOP favouring treatment arms at 2-8 h (WMD = -3.87 mmHg; 95% CI [-4.75, -3.00]; p < 0.001) and 12-24 h (WMD = -2.69 mmHg; 95% CI [-3.36, -2.02]; p < 0.001), with the effect wearing off beyond 1 day (p = 0.18). Between medication classes, the largest effect at both 2-8 h and 12-24 h was observed with intracameral cholinergics or fixed-combination carbonic anhydrase inhibitor-beta-blocker (FCCB) formulations. Conversely, the smallest effect was observed with prostaglandin analogues, alpha-agonists, and topical carbonic anhydrase inhibitors (CAIs).

CONCLUSION

Prophylaxis against acute IOP elevations following uncomplicated cataract surgery is effective. FCCB and intracameral cholinergics are the most effective ocular antihypertensive agents, while alpha-agonists, prostaglandin analogues, and topical CAIs were found to be the least effective. These findings may inform future surgical guidelines.

Prophylactic treatment of intraocular pressure elevation after uncomplicated cataract surgery in nonglaucomatous eyes - a systematic review

The purpose of this systematic review was to evaluate the literature regarding prophylactic treatment of intraocular pressure (IOP) elevation after uncomplicated cataract surgery to provide an evidence-based guideline for cataract surgeons. The relevant literature was identified in EMBASE and PubMed. The risk of bias was assessed according to the 'Cochrane Handbook for Systematic Reviews of Interventions' and the ROBINS-I tool. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) criteria were used to rate the quality of evidence, and relevant data were systematically extracted to evaluate the pressure-lowering effect of the active substances. The primary outcomes for this systematic review were the absolute and relative pressure-lowering effect of the different drugs after 3-8 hr and 1 day after surgery. In total, 23 randomized controlled trials and one nonrandomized controlled study consisting of 45 treatment arms with 14 different active substances were included in the qualitative synthesis. According to the GRADE criteria, nine trials were graded as 'high' quality of evidence, 12 trials as 'moderate', while three trials were given the grade 'low' quality of evidence. The primary outcomes showed most consistency between the trials, which studied the effect of timolol, and presented a relative effect from 18.6% to 29.6% at 3-8 hr and 9.8% to 23.6% at day 1. This systematic review indicates that timolol, latanoprost and travoprost alone or medications containing timolol as an additive active substance, such as dorzolamide + timolol, brinzolamide + timolol and brimonidine + timolol, are characterized by a good relative IOP-lowering effect, which can be gained by a single dose postoperatively.

Effect of Topical Hypotensive Medications for Preventing Intraocular Pressure Increase after Cataract Surgery in Eyes with Glaucoma

PURPOSE

To compare the effects of a topical intraocular pressure (IOP)-lowering medication for preventing an IOP increase after cataract surgery in eyes with glaucoma.

DESIGN

Randomized clinical study.

METHODS

A total of 165 eyes of 165 patients with primary open-angle glaucoma or pseudoexfoliation glaucoma scheduled for phacoemulsification were randomly assigned to 1 of 3 groups to receive each medication immediately postoperatively: 1) prostaglandin F_2α analog (travoprost), 2) β-blocker (timolol maleate), or 3) carbonic anhydrase inhibitor (brinzolamide). Intraocular pressure (IOP) was measured using a rebound tonometer at 1 hour preoperatively, at the end of surgery, and at 2, 4, 6, 8, and 24 hours postoperatively. The incidence of eyes exhibiting a marked IOP increase to greater than 25 mm Hg was compared among the groups.

RESULTS

At 1 hour preoperatively and at the end of surgery, mean IOP did not differ significantly among the groups. Mean IOP increased significantly between 4 and 8 hours postoperatively and then decreased at 24 hours postoperatively in all groups (P < .0001). Mean IOP was significantly lower in the brinzolamide group than in the travoprost or timolol group at 4, 6, and 8 hours postoperatively (P ≤ .0374) and did not differ significantly among groups at 2 and 24 hours postoperatively. The incidence of an IOP spike was significantly lower in the brinzolamide group than in the travoprost and timolol groups (P = .0029).

CONCLUSIONS

Brinzolamide reduces the short-term IOP increase after cataract surgery more effectively than travoprost or timolol in eyes with glaucoma, suggesting that brinzolamide is preferable for preventing an IOP spike.

Brinzolamide-brimonidine fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

AIM

To evaluate the effectiveness of brinzolamide-brimonidine fixed combination to control the intraocular pressure elevation throughout the first 24 h following uncomplicated phacoemulsification cataract surgery.

PATIENTS AND METHODS

A total of 62 patients who underwent phacoemulsification cataract surgery were included in this prospective randomized comparative case series. The brinzolamide-brimonidine fixed combination group (34 eyes) was administered a single dose of brinzolamide-brimonidine fixed combination immediately after phacoemulsification. No treatment was administered in the control group (28 eyes). Intraocular pressure was measured 1 day before surgery (baseline) and at 6, 12 and 24 h postoperatively.

RESULTS

The brinzolamide-brimonidine fixed combination group had significantly lower intraocular pressure at 6, 12 and 24 h after phacoemulsification compared to baseline (p < 0.0001 for all comparisons), while in control group, intraocular pressure was significantly higher at 6 and 12 h after surgery compared to baseline (p < 0.001 and p < 0.0001, respectively). In control group, an intraocular pressure elevation ⩾ 5 mm Hg was noted in 32.4% of the eyes at 6 and 12 h and in 5.9% of eyes at 24 h after surgery, while in brinzolamide-brimonidine fixed combination group, only 8.8% of the eyes at 6 h postoperatively had such an intraocular pressure elevation.

CONCLUSION

The administration of a single drop of brinzolamide-brimonidine fixed combination effectively prevented intraocular pressure elevations and intraocular pressure spikes during the first 24 h after uneventful phacoemulsification.

Non-Self-Sealing (Leaky) Anterior Chamber Paracentesis: A New Technique in Managing Postphacoemulsification Intraocular Pressure Rise in Glaucoma and Normal Eyes

Phacoemulsification (phaco) for cataract extraction is 1 of the most commonly performed ophthalmic surgeries. With increasing evidence of significant intraocular pressure (IOP) reduction after phaco, the paradigm for glaucoma treatment has been shifting toward more cataract extraction instead of glaucoma surgery; thus, the population of glaucoma patients undergoing phaco is likely to continue to increase in the coming years. Although the safety of surgery has improved over the years with newer technologies and machines, postoperative IOP spike remains an important condition even after an uneventful operation. Glaucoma patients undergoing phacoemulsification are particularly at risk of further glaucomatous optic nerve damage from the transient yet potentially high pressures after phaco. Common treatments include topical, intracameral, oral, and systemic IOP-lowering medications; postoperative anterior chamber paracentesis (ACP); and so on. No single treatment to date can guarantee effective prevention or control IOP rise in the first 24 hours after phaco. Sometimes, the IOP remains high despite all of the above treatments and the risk for further glaucomatous damage may be unavoidable. In this perspective article, we discuss the incidence, causes, and treatments of IOP rise after phaco and introduce a new technique, a non-self-sealing (leaky) ACP that may be of use in regulating postoperative IOP rise, especially for patients with glaucoma.

Brimonidine-timolol versus brinzolamide-timolol for treatment of elevated intraocular pressure after phacoemulsification surgery

PURPOSE

To compare the efficacy of the fixed combination of brimonidine-timolol (FCBT) and the fixed combination of brinzolamide-timolol (FCBZT) treatments for elevated intraocular pressure (IOP) after phacoemulsification cataract surgery.

METHODS

A randomised, prospective, double-blinded study was conducted on 277 eyes of 257 patients who underwent phacoemulsification cataract surgery. Patients were divided into three groups based on the medication administered after cataract surgery as follows: FCBT, FCBZT and a control group where no antiglaucoma medications were used. IOP was recorded at preoperative and postoperative hours 6 and 24 and days 3 and 5.

RESULTS

No statistical differences were observed among the groups regarding age, sex and baseline IOP levels (p > 0.05). Mean IOP levels were significantly lower in the treatment groups than in the control group at postoperative hours 6 and 24 and days 3 and 5 (p < 0.001). Administration of one drop of FCBT or FCBZT demonstrated similar effects on preventing IOP spikes within 24 h of phacoemulsification cataract surgery. FCBZT more effectively lowered IOP than FCBT at days 3 and 5 (p < 0.05).

CONCLUSIONS

We demonstrate that the postoperative administration of FCBT or FCBZT is effective in lowering IOP after phacoemulsification cataract surgery; FCBZT more effectively lowered IOP than FCBT at postoperative days 3 and 5.

Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy

PURPOSE

To evaluate intraocular pressure (IOP) immediately after cataract surgery with or without ab interno trabeculectomy (Trabectome) and whether trabeculectomy-related hyphema increases the risk for IOP spikes.

SETTINGS

Private glaucoma practice.

DESIGN

Retrospective interventional nonrandomized comparative chart review.

METHODS

Intraocular pressure was measured 3 to 4 hours and 20 hours postoperatively.

RESULTS

The combined group comprised 73 eyes of 73 patients and the cataract-only group, 75 eyes of 75 patients. The mean preoperative IOP was 15.8 mm Hg ± 3.6 (SD) and 14.9 ± 3.0 mm Hg, respectively (P = .09). In the combined group, the IOP decrease was significant at 3 to 4 hours (P = .0003) and 20 hours (P = .0007). In the cataract-only group, the IOP increased significantly (P < .0001 and P = .0035, respectively). The mean IOP was significantly lower in the combined group than in the cataract-only group at 3 to 4 hours (12.8 ± 5.9 mm Hg versus 19.7 ± 7.5 mm Hg) and 20 hours (12.7 ± 7.0 mm Hg versus 17.2 ± 5.9 mm Hg) (both P < .0001). Significantly fewer eyes in the combined group than in the cataract-only group had IOP spikes (overall, P = .0077; 3 to 4 hours, P = .001). Hyphema occurred in 35 eyes (47.9%) in the combined group; however, the IOP was similar with or without hyphema. Only 1 eye with an IOP spike in the combined group had hyphema.

CONCLUSION

Combining ab interno trabeculectomy and cataract surgery reduced short-term postoperative IOP and the incidence of IOP spikes despite the common hyphema.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension?

PURPOSE

To determine whether the 1-day postoperative intraocular pressure (IOP) check following routine uncomplicated phacoemulsification is necessary in patients with pre-existing glaucoma and ocular hypertension (OHT), if acetazolamide prophylaxis is used. To investigate the practice of U.K. glaucoma specialists in IOP rise prophylaxis and follow-up regimes.

PATIENTS AND METHODS

The IOP 1-day postoperatively was analysed against the last recorded IOP before phacoemulsification in a cohort of patients with glaucoma or OHT who underwent uncomplicated phacoemulsification cataract surgery between December 2009 and September 2012, where it was routine practice to give acetazolamide postoperatively. U.K. and Eire Glaucoma Society members were surveyed via an online questionnaire to analyse practice among U.K. glaucoma specialists.

RESULTS

One hundred and seven eyes were studied: 99 with glaucoma and 8 with OHT. The mean IOP change was -0.8 mm Hg with only two eyes measuring >30 mm Hg postoperatively (2%). Both these eyes received 750 mg acetazolamide. Eighteen (17%) eyes had an IOP rise of at least 30%. In the survey of practice there were 65 respondents. Twenty-one (32%) respondents did not use IOP prophylaxis. Only 17 (26%) of respondents routinely reviewed their patients 1-day postoperatively.

CONCLUSION

Our prophylactic acetazolamide regime does not completely eliminate the risk of an IOP >30 mm Hg on day 1 post routine phacoemulsification in glaucoma/OHT patients. Patients with pre-existing glaucoma, despite acetazolamide prophylaxis, will require IOP management decisions on the first postoperative day after uncomplicated phacoemulsification surgery. U.K. expert practice is non-uniform with regard to IOP prophylaxis, and the 1-day review, and further discussion and formulation of consensus appears necessary.

Effect of 1% brinzolamide and 0.5% timolol fixed combination on intraocular pressure after cataract surgery with phacoemulsification

AIM

To evaluate the effect of brinzolamide-timolol fixed combination on intraocular pressure (IOP) after cataract surgery.

METHODS

The study included 92 eyes of 87 patients who underwent cataract surgery and intraocular lens implantation. Patients scheduled for phacoemulsification were assigned to 1 of 2 groups. The treatment group received 1 drop of brinzolamide-timolol fixed combination immediately after surgery, and the control group received no treatment. The IOP was measured preoperatively and at 2h and 24h postoperatively.

RESULTS

The mean IOP change was lower in the treatment group than in the control group at 2h postoperatively. The difference between the mean IOP values of the two groups at 2h postoperatively was found to be statistically significant. Twenty-four hours after the surgery, the mean IOP change was still higher in the control group when compared to the treatment group.

CONCLUSION

The fixed combination brinzolamide-timolol can effectively reduce IOP after cataract surgery.

Brinzolamide-timolol fixed combination for the prevention of intraocular pressure elevation after phacoemulsification

BACKGROUND

To evaluate the efficacy of brinzolamide-timolol fixed combination in intraocular pressure during the first 24 h after uneventful phacoemulsification cataract surgery using Viscoat and Provisc.

DESIGN

Prospective randomized comparative case series.

PARTICIPANTS

Ninety-two eyes of equal patients scheduled for phacoemulsification cataract surgery.

METHODS

Treatment group (52 eyes) received a drop of brinzolamide-timolol fixed combination immediately after surgery. Control group (40 eyes) received no treatment.

MAIN OUTCOME MEASURES

Intraocular pressure preoperatively and at 6, 12 and 24 h postoperatively.

RESULTS

Six hours after surgery the mean intraocular pressure decreased by 0.3 ± 2.95 mmHg (P > 0.05) in the treatment group and increased by 6.8 ± 2.78 mmHg (P < 0.001) in the control group. Twelve hours postoperatively, the mean intraocular pressure increased by 0.23 ± 3.49 mmHg (P > 0.05) in the treatment group and by 5.3 ± 3.26 mmHg (P < 0.001) in the control group. Twenty-four hours after surgery, the mean intraocular pressure decreased by 1.76 ± 2.83 mmHg (P < 0.01) in the treatment group and in the control group increased by 1.4 ± 2.46 mmHg (P > 0.05). The intraocular pressure in the treatment group was statistically significantly lower compared with the control group at 6, 12 and 24 h postoperatively. None of the eyes in the treatment group had postoperative intraocular pressure elevation ≥10 mmHg; such an increase was recorded in 20% and 10% of control eyes at 6 and 12 h after surgery, respectively.

CONCLUSION

A single dose of brinzolamide-timolol fixed combination after phacoemulsification cataract surgery prevented a significant intraocular pressure increase during the first 24 h postoperatively.

Short-term changes in intraocular pressure after phacoemulsification in glaucoma patients

PURPOSE

To evaluate short-term intraocular pressure (IOP) changes after phacoemulsification in glaucoma and normal patients and the effect of oral acetazolamide (Diamox) to control IOP in these patients.

METHODS

120 patients undergoing cataract surgery were included in this prospective multicenter study involving 6 University Eye Clinics: 60 patients with well-controlled primary open-angle glaucoma (POAG) and 60 controls. Half of the study participants received oral acetazolamide, 250 mg, 1 and 6 h after surgery. The treated and untreated groups were matched for age and density of cataract. All patients underwent a standard phacoemulsification procedure and were checked for IOP with Goldmann tonometry in the morning before surgery and then at 3, 6, 21 and 24 h postoperatively by a masked evaluator.

RESULTS

The group with POAG showed a significant postsurgical increase in IOP (p < 0.001) at all time points. Six of thirty (20%) untreated POAG patients showed at least 1 IOP reading above 30 mm Hg whereas acetazolamide significantly reduced postoperative IOP at all time points (p < 0.01) and in no case was IOP >30 mm Hg. The control group had high IOP during the first 6 h (p < 0.01), but normal values thereafter.

CONCLUSION

A significant short-term IOP increase may be found after phacoemulsification both in POAG and normal patients; this is not dangerous in normal subjects, but can be potentially dangerous in POAG patients. The use of systemic acetazolamide provided significant control of IOP and could be considered a 'possible standard' management of cataract surgery in POAG patients.

Effect of latanoprost/timolol and dorzolamide/tiomolol on intraocular pressure after phacoemulsification surgery

AIM

To evalaute the effect of fixed-combination latanoprost 0.005%/timolol maleate 0.5% and dorzolamide hydrochloride 2%/timolol maleate 0.5% on postoperative intraocular pressure after phacoemulsification cataract surgery.

METHODS

This study is a prospective, randomized, double-masked and placebo-controlled. The study included 90 eyes of 90 patients which were scheduled to have phacoemulsification surgery. Patients were randomly assigned preoperatively to 1 of 3 groups (30 eyes of 30 patients). Two hour before surgery, the patients received one drop latanoprost/timolol (group 1), dorzolamide/timolol (group 2) and placebo (group 3, control group). The IOPs were measured at preoperative and postoperative 4, 8, and 24 hours.

RESULTS

The preoperative mean intraocular pressure was not statistically significant between both drug groups and control group. In group 1 and 2, the postoperative mean IOP [group1: (14.03±3.15)mmHg and group 2: (14.16±4.43)mmHg] at 24 hours were significantly lower than the control group [(16.93±3.70)mmHg, (P<0.05)]. In addition, the postoperative mean IOP of group 1 [(14.90±3.69)mmHg] at 8 hours was significantly lower than the control group [(17.70±3.89)mmHg, (P<0.05)], but there was no significant difference between group 2 [(16.16±5.23)mmHg] and control group at 8 hours (P>0.05).

CONCLUSION

When compared with placebo, the use of preoperative fixed combination of latanoprost/timolol and dorzolamide/timolol is an effective method for preventing intraocular pressure elevation in 24 hours after phacoemulsification surgery, but did not completely prevent IOP spikes.

Intraocular Pressure Elevation within the First 24 Hours after Cataract Surgery in Patients with Glaucoma or Exfoliation Syndrome

OBJECTIVE

To investigate whether eyes with glaucoma or exfoliation syndrome without glaucoma are prone to exhibit intraocular pressure (IOP) elevation shortly after cataract surgery and, if so, whether timolol maleate 0.5% reduces these spikes.

DESIGN

Prospective randomized double-masked clinical trial.

PARTICIPANTS

One hundred twenty-two patients with normal eyes, medically well-controlled glaucoma, or exfoliation syndrome who underwent uneventful phacoemulsification cataract extraction.

METHODS

Patients were randomly assigned to an immediately postoperative drop of either timolol maleate 0.5% or no treatment. Intraocular pressure was measured preoperatively and 4, 8, and 24 hours and 1 week later.

MAIN OUTCOME MEASURES

Intraocular pressure measurements.

RESULTS

The changes in postoperative IOP over time differed significantly between glaucoma, exfoliation syndrome, and normal (P = 0.005). Intraocular pressure was significantly lower in the normal group (n = 25) than in both the glaucoma (n = 18) and exfoliation syndrome (n = 19) groups (P<0.001). With 1 drop of prophylactic timolol maleate 0.5% at completion of surgery, the normal group (n = 25) again had IOP significantly lower than those of the glaucoma (n = 15) and exfoliation syndrome (n = 20) groups (P<0.001). Treatment with timolol maleate 0.5% significantly changed postoperative IOP over time in the glaucomatous eyes (P = 0.003), but it made no difference in the exfoliation syndrome (P = 0.4) or normal (P = 0.5) eyes. Intraocular pressure > 25 mmHg did not occur among normal eyes. Intraocular pressure > 25 mmHg and > 30 mmHg occurred in 10 (55%) and 5 (28%) glaucoma patients, respectively, and 5 (27%) and 2 (11%) exfoliation syndrome patients, respectively. Timolol maleate 0.5% eliminated IOP spikes > 30 mmHg and reduced the frequency of IOP > 25 mmHg in both groups to 14% in the glaucoma group and 5% in the exfoliation syndrome group. Most IOP elevation occurred at 4 hours postoperatively. The mean IOP was <20 mmHg in all groups 1 day postoperatively.

CONCLUSIONS

Medically well-controlled glaucoma patients and patients with exfoliation syndrome may experience IOP elevation shortly after cataract surgery. Instillation of timolol maleate 0.5% at the end of the procedure in this series eliminated IOP > 30 mmHg, but IOP elevation below that level can still occur.

Effect of bimatoprost on intraocular pressure after phacoemulsification in eyes with exfoliation syndrome

PURPOSE

To evaluate the effect of bimatoprost 0.03% on intraocular pressure (IOP) after phacoemulsification in eyes with exfoliation syndrome.

METHODS

This prospective, randomized, masked study comprised 90 eyes of 90 patients scheduled for phacoemulsification. The patients were divided into three groups (group 1 = without exfoliation, group 2 = with exfoliation syndrome, group 3 = exfoliation syndrome + bimatoprost). Immediately after phacoemulsification, one drop of bimatoprost was instilled in eyes in group 3. Baseline IOP was measured 1 day before surgery and routine follow-ups were performed at 6 hours, 20-24 hours and 1 week postoperatively.

RESULTS

Preoperative IOP was 15.0 +/- 2.7 mmHg in group 1, 15.6 +/- 3.2 mmHg in group 2 and 16.1 +/- 3.2 mmHg in group 3 (p = 0.372). Six hours postoperatively, there was a significant difference between the groups (p = 0.013): IOP in group 2 (22.4 +/- 7.3 mmHg) was higher than in group 1 (18.4 +/- 4.4 mmHg) (p = 0.018) and group 3 (18.9 +/- 4.9 mmHg) (p = 0.044). In all groups, IOP values at 6 hours postoperatively were higher than preoperative values (p < 0.001), but IOP values at 20-24 hours and 1 week after surgery were not significantly different from baseline values (p > 0.05). The change in IOP in group 2, from baseline to 6 hours postoperatively, was greater than the equivalent changes in group 1 (p = 0.048) and group 3 (p = 0.016).

CONCLUSIONS

Transient IOP increase and spikes were more common in eyes with exfoliation syndrome. Postoperative application of bimatoprost was effective in reducing IOP and preventing IOP spikes >/= 30 mmHg in eyes with exfoliation syndrome in the early postoperative period.

Brinzolamide 1% versus apraclonidine 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy

PURPOSE

To compare the efficacy of brinzolamide 1% with that of apraclonidine 0.5% in preventing intraocular pressure (IOP) rise after neodymium:YAG (Nd:YAG) laser posterior capsulotomy.

SETTING

Department of Ophthalmology, Akdeniz University, Antalya, Turkey.

METHODS

One hundred fifteen patients who had Nd:YAG laser posterior capsulotomy for posterior capsule opacification were prospectively randomized to receive brinzolamide 1% (57 patients) or apraclonidine 0.5% (58 patients) approximately 1 hour before laser surgery. A masked observer measured IOP by Goldmann applanation tonometry before treatment and after treatment at 1, 2, and 3 hours and 7 days.

RESULTS

The mean IOP changes from baseline were not statistically different between the study groups at 1, 2, and 3 hours and 7 days (P =.109, P = .764, P =.275, and P =.879, respectively). The incidence of IOP elevation of 5 mm Hg or higher was 12.2% (7 of 57 eyes) in the brinzolamide group and 10.3% (6 of 58 eyes) in the apraclonidine group (P = .743); IOP elevations of 10 mm Hg and greater occurred in 3.5% (2 of 57 eyes) and 1.7% (1 of 58 eyes) (P = .618), respectively. There were no IOP elevations greater than 20 mm Hg in either group.

CONCLUSION

Brinzolamide 1% and apraclonidine 0.5% given prophylactically before Nd:YAG laser capsulotomy were effective in preventing IOP spikes after treatment.