Objective

To evaluate risk factors for intraocular pressure (IOP) spike following cataract surgery using the IRIS® Registry (Intelligent Research in Sight).

Design

Retrospective clinical cohort study.

Subjects

Adults with IRIS® Registry data who underwent stand-alone phacoemulsification from January 1, 2013 to September 30, 2019.

Methods

IOP spike was defined as a postoperative IOP >30 mmHg and >10 mmHg from baseline within the first postoperative week. Odds ratios (OR) for demographic and clinical characteristics were calculated with univariate and multivariate logistic regression analyses.

Main Outcome Measures

Incidence and OR of IOP spike.

Results

We analyzed data from 1,191,034 eyes (mean age 71.3 years, 61.2% female sex and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma and 3.2% of eyes without glaucoma (P<0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR 1.57 per 3 mmHg), male sex (OR 1.79), glaucoma (OR 1.19), Black race (OR 1.39 compared to Asian and OR 1.21 compared to Hispanic), older age (OR 1.07 per 10 years), and complex surgery coding (OR 1.22, all P<0.0001). Diabetes (OR 0.90) and aphakia after surgery (OR 0.60) appeared to be protective against IOP spike (both P<0.0001). Compared to glaucoma suspects, there was a greater risk of IOP spike with ocular hypertension (OR 1.55), pigmentary glaucoma (OR 1.56), and pseudoexfoliative glaucoma (OR 1.52), and less risk for normal tension glaucoma (OR 0.55), primary angle closure (PAC) suspect (OR 0.67), and PAC glaucoma (OR 0.81, all P<0.0001). More baseline glaucoma medications was associated with IOP spike (OR 1.18 per medicine) while topical beta-blocker use (OR 0.68) was protective (both P<0.0001).

Conclusions

Higher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with an early postoperative IOP spike whereas diabetes and postoperative aphakia were protective against a spike following stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on subtype of glaucoma. The findings may help surgeons stratify and mitigate the risk of IOP spike after cataract surgery.

中文翻译：

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智能研究视觉 (IRIS®) 登记中独立超声乳化术后眼压峰值

客观的

使用 IRIS®Registry（智能研究视野）评估白内障手术后眼压 (IOP) 峰值的危险因素。

设计

回顾性临床队列研究。

科目

具有 IRIS® 注册数据且在 2013 年 1 月 1 日至 2019 年 9 月 30 日期间接受独立超声乳化手术的成人。

方法

眼压峰值定义为术后第一周内眼压相对于基线>30 mmHg 和>10 mmHg。通过单变量和多变量逻辑回归分析计算人口统计学和临床​​特征的优势比（OR）。

主要观察指标

IOP 峰值的发生率和 OR。

结果

我们分析了 1,191,034 只眼睛的数据（平均年龄 71.3 岁，61.2% 为女性，24.8% 患有青光眼）。3.7% 的所有眼睛、5.2% 的青光眼眼睛和 3.2% 的非青光眼眼睛出现 IOP 峰值 (P<0.0001)。对所有眼睛的多变量分析表明，基线眼压（OR 1.57/3 mmHg）、男性（OR 1.79）、青光眼（OR 1.19）、黑人种族（与亚洲人相比，OR 1.39，与亚洲人相比，OR 1.21）的眼压峰值风险更大。西班牙裔）、年龄较大（OR 1.07 每 10 年）和复杂的手术编码（OR 1.22，所有 P<0.0001）。手术后糖尿病（OR 0.90）和无晶状体眼（OR 0.60）似乎对 IOP 峰值具有保护作用（均 P<0.0001）。与疑似青光眼患者相比，眼压峰值伴高眼压症（OR 1.55）、色素性青光眼（OR 1.56）和假性剥脱性青光眼（OR 1.52）的风险较高，而正常眼压性青光眼（OR 0.55）、原发角的风险较低。闭合（PAC）可疑（OR 0.67）和PAC青光眼（OR 0.81，所有P<0.0001）。更多基线青光眼药物与 IOP 峰值相关（每种药物 OR 1.18），而局部使用 β 受体阻滞剂（OR 0.68）具有保护作用（均 P<0.0001）。

结论

较高的基线眼压、男性、青光眼、黑人种族、年龄较大和复杂的白内障编码与术后早期眼压峰值相关，而糖尿病和术后无晶状体眼对单独超声乳化术后眼压峰值具有保护作用。青光眼的眼睛表现出不同的风险状况，具体取决于青光眼的亚型。这些发现可能有助于外科医生分层并降低白内障手术后眼压峰值的风险。