Comparative Efficacy of Acetazolamide and Apraclonidine in the Control of Intraocular Pressure following Phacoemulsification

Bach‐Holm

et al. 2019

Acta Ophthalmologica

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.

Section: Resultsmentioning

confidence: 99%

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

Bach‐Holm

et al. 2019

Acta Ophthalmologica

“…The difference between preoperative and postoperative IOP did not reflect a significant difference in the two groups (p = 0.3919, paired t-test) (Table 3). Three eyes received hypotensive treatment on the first postoperative day; two were treated with topical apraclonidine 0.5% and one received oral acetazolamide [24,25].…”

Section: Resultsmentioning

confidence: 99%

Deep topical anesthesia with ropivacaine-soaked sponge for phacoemulsification

Scuderi

Calafiore

et al. 2019

Int Ophthalmol

Self Cite

Purpose To assess safety and efficacy of deep topical anesthesia with ropivacaine-soaked sponge compared with topical anesthesia with oxybuprocaine in patients undergoing phacoemulsification. Methods This was a retrospective study where records of patients operated for cataract were evaluated. Patients using a visual analogue scale scored pain during surgery, and the surgeon on a questionnaire recorded ease of operation. Medical records were evaluated for patients who received topical anesthesia with multiple administrations of oxybuprocaine 0.4% or those who received deep topical anesthesia with a polyvinyl acetal sponge impregnated with ropivacaine 0.75% and positioned under the eyelid 30 min before surgery.Results A total of one hundred patient records, equally divided in patients receiving deep topical anesthesia or topical anesthesia, were included. The visual analogue scale scores among the groups were statistically significant for a lower pain score in patients who received deep topical anesthesia with ropivacaine-soaked sponges (p = 0.0069). The average surgeon score was significantly higher for the deep topical anesthesia group indicating favorable ease of surgery (p = 0.0341). Six patients had major complications during surgery. No additional anesthesia was necessary to manage the complications in four patients in the deep anesthesia group, whereas propofol was used for the induction and maintenance of anesthesia in two patients in the topical anesthesia group. Conclusions Deep topical anesthesia with ropivacaine-soaked sponges performed as well as topical oxybuprocaine regarding safety and efficacy. It provided a lower patient pain score, favorable surgeon satisfaction, and long-lasting anesthesia.

European Journal of Ophthalmology

“…15 Topical brinzolamide 11 and its fixed combination with timolol 10 were found effective by Dayanir et al and Georgakopoulos et al, respectively. Furthermore, brimonidine was proved efficacious by Rainer et al, 14 Pharmakakis et al 9 proved the effectiveness of brimonidine-timolol eye drops solution and Scuderi et al 12 showed the effectiveness of topical apraclonidine. Topical timolol maleate controlled effectively postoperative IOP elevations as reported by Borazan et al 16 The aim of this study was to evaluate the efficacy of BBFC in preventing IOP elevation during the first 24 postoperative hours, in eyes that underwent uncomplicated phacoemulsification cataract surgery with Viscoat and Provisc as OVDs.…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of several antiglaucoma drugs on IOP control following cataract surgery has been widely studied. [9][10][11][12][13][14][15][16] The first fixed combination of antiglaucomatic drugs without beta-blocker was approved recently for commercial use in Europe. Simbrinza (Alcon Pharma GmbH, Puurs, Belgium) consists of brinzolamide 1%, a carbonic anhydrase inhibitor, and brimonidine 0.2%, an α 2 -agonist.…”

Section: Introductionmentioning

confidence: 99%

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

Georgakopoulos

Kagkelaris

Pagoulatos

et al. 2018

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.