1. Risk Factors for Early Intraocular Pressure Elevation After Cataract Surgery in a Cohort of United States Veterans
- Author
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Irene M Lee, Paul B. Greenberg, Allison J. Chen, Kaushik Annam, Jorge J Rivera, and Alfred A Paul
- Subjects
Male ,medicine.medical_specialty ,Intraocular pressure ,genetic structures ,medicine.medical_treatment ,Glaucoma ,Ocular hypertension ,Cataract Extraction ,Preoperative care ,Cataract ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Humans ,Medicine ,Veterans Affairs ,Intraocular Pressure ,Aged ,Veterans ,Aged, 80 and over ,Chi-Square Distribution ,business.industry ,Public Health, Environmental and Occupational Health ,Rhode Island ,General Medicine ,Cataract surgery ,medicine.disease ,eye diseases ,Surgery ,Logistic Models ,Cohort ,030221 ophthalmology & optometry ,Female ,Ocular Hypertension ,sense organs ,business ,Complication ,030217 neurology & neurosurgery - Abstract
INTRODUCTION Cataract surgery is the most frequently performed surgery in the Veterans Health Administration (VHA). A well-known complication is a transient but potentially harmful elevation in intraocular pressure (IOP) within the 24-h postoperative period. The purpose of this study is to investigate the risk factors for IOP elevation 1 d after cataract surgery in a cohort of United States (US) veterans. MATERIALS AND METHODS The study included 784 patients who underwent cataract surgery between April 2013 and April 2016 at a single Veterans Affairs medical center in Providence, RI. One thousand one hundred thirty-seven cataract surgeries were considered in total. Institutional Review Board (IRB) approval was obtained through the Providence Veterans Affairs Medical Center (PVAMC). Logistic regression, adjusted for patients with bilateral surgeries, was used to evaluate risk factors for first postoperative day IOP elevation (≥28 mmHg). The main outcome measure was elevated IOP on postoperative day 1 (POD1) after cataract surgery. RESULTS The average patient age was 74 yr. Ninety-eight percent (1,110/1,137) of cases involved male patients; 75.3% (856/1,137) of the cataract surgeries were performed by resident surgeons. Type II diabetes mellitus (DM) was present in 41% (461/1,137), alpha-1 blocker use in 31% (358/1,137), ocular hypertension (ocular HTN) in 4% (44/1,137), and glaucoma in 11% (126/1,137) of cases. Twenty-two percent (232/1,137) of eyes had elevated IOP. Independent risk factors were a history of ocular HTN (OR: 8.74 [4.03-18.9]), glaucoma (OR: 3.54 [2.17-5.75]), a preoperative IOP ≥22 mmHg (OR: 2.51 [1.12-5.62]), and complicated cataract surgery (OR: 2.45 [1.18-5.08]), defined as vitreous loss, anterior capsular tear (ACT), posterior capsular tear (PCT), or presence of zonular lysis. CONCLUSION These findings suggest that cataract surgery patients with ocular HTN, glaucoma, a preoperative IOP ≥22 mmHg, or significant intraocular complications may benefit from prophylactic ocular anti-hypertensive medication.
- Published
- 2018
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