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EW INTERNATIONAL 112 September 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer vitreous loss were excluded from the study. The primary study measures were postoperative IOP and best corrected visual acuity (BCVA). The mean preoperative BCVA of group 1 was 0.83 ± 0.21 logMAR (range: 0.30–1.00 logMAR) and that of group 2 was 0.78 ± 0.24 logMAR (range: 0.4–1.00 logMAR), with no statistically significant difference between the two groups (P=.312). The mean postoperative IOP in group 1 at 1 year after cataract surgery was 14.60 ± 3.21 mm Hg (range: 11–21 mm Hg) and that of the second group was 14.67 ± 2.77 mm Hg (range: 11–21 mm Hg), with no statistically significant difference between the two groups (P=.924). Looking at IOP outcomes in the immediate postoperative period demonstrated a mean postoperative IOP in group 1 on day 1 of 15.27 ± 2.90 mm Hg (range: 11–23 mm Hg) and in group 2 of 14.82 ± 2.57 mm Hg (range: 11–23 mm Hg). There was no statistically significant differ- ence between the two groups on day 1 (P=.505). The mean postoperative IOP of group 1 at week 1 was 13.72 ± 2.44 mm Hg (range: 10–18 mm Hg), while that of group 2 was 13.64 ± 2.53 mm Hg (range: 10–19 mm Hg), with no statistically significant difference between the two groups at week 1 (P=.895). Carbonic anhydrase inhibitors Acetazolamide, dorzolamide, and brinzolamide all belong to a group of agents known as carbonic anhy- drase inhibitors (CAI). "CAIs have been used to treat glaucoma system- ically since 1954," Dr. Cetinkaya said. "CAIs decrease aqueous humor synthesis by inhibiting carbonic anhydrase isozyme II and are very effective in reducing IOP. However, they have many side effects. In our study, we detected adverse effects of oral acetazolamide like headache, fatigue, polyuria, paraesthesia, nau- sea, and vomiting. However, neither systemic nor ocular side effects were observed in patients who received the topical dorzolamide-timolol ma- leate combination. Dorzolamide and brinzolamide are two topical CAIs that are currently available to treat ocular hypertension and glaucoma. Dorzolamide is a potent inhibitor of carbonic anhydrase isozyme II. Its gone phacoemulsification and IOL implantation surgery between January 2012 and June 2012. The patients were divided into two groups receiving either systemic or topical medication for a probable postoperative IOP rise. Group 1 comprised 33 patients (49%) who received oral acetazolamide 250 mg 1 hour prior to surgery and 1 hour immediately following surgery, and 125 mg acetazolamide three times daily for 3 days after surgery. Group 2 comprised 34 patients (51%) who received a topical dorzolamide-tim- olol maleate combination drop, 1 hour prior to surgery and twice daily for 3 days after surgery. The mean age of the patients was 62.52 ± 10.45 years (range: 43–83 years). Full ophthalmologi- cal examinations were performed preoperatively, as well as at day 1, week 1, month 1, month 3, month 6, and year 1 following the surgery. Patients with glaucoma or any ocu- lar or systemic diseases that might affect their vision and patients who had intraoperative complications like posterior capsule rupture and implantation in cataract surgery," Dr. Cetinkaya said. "However, when it is not removed completely, it may cause IOP to rise within the first 24 hours following cataract surgery. Other causes that can contribute to elevated IOP after cataract surgery are retained lens content, iris pig- ment release, and hyphema caused by surgical trauma. Postoperative IOP rise may cause pain, discomfort, corneal edema, optic nerve damage, and visual field loss in patients with preexisting glaucoma. Additionally, it may cause non-arteritic anterior ischemic optic neuropathy, central retinal arterial, or vein occlusion in susceptible patients. Different agents like intracameral carbachol and ace- tylcholine, pilocarpine, beta block- ers, prostaglandin analogues, and oral or topical carbonic anhydrase enzyme inhibitors may be used to prevent postoperative IOP spikes." Treatment comparison Dr. Cetinkaya's study involved the retrospective evaluation of 67 eyes of 67 patients with cataract (33 male, 34 female) who had under- Topical dorzolamide-timolol maleate combination therapy rivals effects of systemic acetazolamide for postoperative IOP control, with none of its adverse side effects R ises in intraocular pressure following cataract surgery need to be carefully con- trolled. At the 21st Winter Meeting of the European Society of Cataract & Refractive Sur- geons (ESCRS), a Turkish study was presented that compared the efficacy of two approaches, one topical and the other systemic, on post-cataract surgery IOP. Servet Cetinkaya, MD, Turkish Red Crescent Hospital, Oph- thalmology Clinics, Konya, Turkey, discussed the causes of postoperative IOP rises and his method of choice in keeping pressures down. "Viscoelastic substance main- tains the anterior chamber, protects the corneal endothelium, and facil- itates both capsulorhexis and IOL Keeping pressure down after cataract surgery Presentation spotlight A Turkish study compared the efficacy of two approaches, one topical and the other systemic, on post-cataract surgery IOP. continued on page 114

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