Early IOP Spike Post Cataract Surgery?

HOT TOPIC

IOP Spike After Stand-Alone Phacoemulsification

A study published in Ophthalmology shows that IOP spike after cataract surgery has a rate of 3.7%, according to data from the Intelligent Research in Sight (IRIS) Registry. This analysis also shows that other factors influencing an early postop IOP spike include higher baseline IOP, male sex, Black race, more complicated surgical procedures, and older age.

The study was conducted by researchers at the Bascom Palmer Eye Institute in Miami to see if certain demographic or clinical factors are associated with an increased risk of an IOP spike early in the patient’s postoperative period. They analyzed only standalone phacoemulsification procedures and used the national IRIS Registry to draw their conclusions. The data used included 1,191,034 eyes over a period of 7 years with a mean patient age of 71.3 years. Of the patients included, 61% were female and nearly 25% had glaucoma.

Some more interesting data points included IOP spikes occurring in 3.7% of all eyes analyzed and 5.2% of eyes with glaucoma. Also of interest is the fact that diabetes and postoperative aphakia were found to have a protective effect against IOP spike following stand-alone phacoemulsification.

My Two Cents

As someone who has seen a lot of postop cataract cases in my career, this study makes sense to me intuitively. Most of my IOP spikes have been in Black male patients, and that ~5% rate also seems pretty accurate. The article's authors note that, “Given our results, one could consider administering topical beta blockers for patients at the highest risk of IOP spike.” Perhaps my colleagues and I will try this for our patients who are known steroid responders.

OUTSIDE THE LANE

Are Donkeys the New Guide Animal?

Here’s your feel-good story of the week: in this adorable TikTok video, Petey, a seeing eye donkey, is shown taking care of Luna, his blind horse friend. Petey’s TikTok account, @peteythetalkingdonkey, features various videos, but the one profiled here shows Petey guiding Luna into the stable and ensuring she follows by constantly making noises and letting Luna listen to the sound of his footsteps. (Read more here.)

My Two Cents

Hold on while I look into adopting a pet donkey. How sweet is this? It makes me want to immediately grab my dog and tell him how special he is and how awesome animals are. Also, while I totally love this story, let’s hope it doesn’t start a new trend of patients showing up in our waiting rooms with their guide donkeys!

CAN YOU RELATE

I want to issue an apology and clarification to the ODs in Utah. Last week’s newsletter mentioned a new bill being pushed in the Utah legislature, and I wrote, “This is pure insanity, and it is no surprise that Utah, home of 1-800 Contacts, is leading the way.”

This in no way was meant to disparage Utah ODs. Rather, I was letting my disgust be known regarding this new bill, which is obviously being backed by 1-800 Contacts. Hats off to all the hard-working doctors out there, such as David Meyer, OD, FAAO, who are doing their best to oppose these damaging bills. Keep up the good fight and keep putting our patients’ safety first!

On another note, those who know me know how much I enjoy podcasts. One of my personal favorites is Ophthalmology Off the Grid, hosted by my good friend and coworker Blake Williamson, MD, MPH, and his friend Gary Wörtz, MD. In their most recent episode, they profile a case that Blake and I worked on together of a bilateral ICL that looked like bilateral endophthalmitis, acted like bilateral endophthalmitis, had me, a retina specialist, and two cataract/refractive ophthalmologists convinced it was bilateral endophthalmitis, but thankfully was not bilateral endophthalmitis. Give it a listen, and pay special attention around the 14-minute mark!

IMAGE OF THE WEEK

Krukenberg spindle in pigmentary glaucoma.

QUOTE OF THE WEEK

“In the midst of chaos, there is also opportunity.”

— Sun Tzu, Chinese military general, strategist, philosopher, and writer who lived during the Eastern Zhou period (771-256 BC)