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

Abstract

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.

Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management

“…In one recent investigation, PGAs have recently been recommended for the prophylactic treatment of IOP elevation after uncomplicated cataract surgery. 42 As previously mentioned in this review, the use of PGAs typically does not cause CME in phakic patients with a normally functioning blood-ocular barrier but may increase the incidence of CME after cataract surgery. 3,30,129 In a retrospective study comprising data from 1659 cataract surgeries, preoperative use of PGAs was associated with a significant risk of the development of CME when patients with diabetes mellitus were excluded (odds ratio ¼ 12.45).…”

Post-operative Day Zero Versus Day One Follow-Up for Uncomplicated Cataract Surgery

“…At the time those studies were completed, no definitive recommendations for IOP elevation prophylaxis were available. Since then, randomized clinical trials have found that a single dose of timolol, latanoprost, or travoprost can consistently lower IOP for patients, post-operatively [ 18 ]. However, it is still difficult to predict which patients would develop an IOP spike.…”