Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

Alcina K. Lidder; Elizabeth A. Vanner; Ta Chen Chang; Flora Lum; Adam L. Rothman

doi:10.1016/j.ophtha.2024.01.022

Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

Alcina K. Lidder, Elizabeth A. Vanner, Ta Chen Chang, Flora Lum, Adam L. Rothman^*

^*Corresponding author for this work

Ophthalmology

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Purpose: To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS® Registry (Intelligent Research in Sight). Design: Retrospective clinical cohort study. Participants: Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. Methods: Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. Main Outcome Measures: Incidence and OR of IOP spike. Results: We analyzed data from 1 191 034 eyes (patient 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, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. 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) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-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 early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Original language	English (US)
Pages (from-to)	780-789
Number of pages	10
Journal	Ophthalmology
Volume	131
Issue number	7
DOIs	https://doi.org/10.1016/j.ophtha.2024.01.022
State	Published - Jul 2024

Funding

Supported in part by Research to Prevent Blindness, Inc., New York, New York, and the American Academy of Ophthalmology, San Francisco, California (2020 Award for IRIS\u00AE Registry Research); the National Institutes of Health, Bethesda, Maryland (grant no.: P30EY013810); and Research to Prevent Blindness (unrestricted grant). The sponsor or funding organizations participated in the design of the study, conducting the research, data collection, data management, and review and approval of the manuscript. The sponsor or funding organization had no role in the design or conduct of this research. A.K.L.: Financial support \u2013 Bascom Palmer Eye Institute, Alcon, AbbVie E.A.V.: Financial support \u2013 National Eye Institute, Research to Prevent Blindness/American of Ophthalmology Award for IRIS\u00AE Registry Research; Equity owner \u2013 Greenlight Biosciences GRNA T.C.C.: Financial support \u2013 Research to Prevent Blindness, Inc.; Royalties \u2013 Clinical Decisions in Glaucoma, 2nd ed.; Medical Advisory Board \u2013 Sturge Weber Foundation A.L.R.: Financial support \u2013 American Academy of Ophthalmology/Research to Prevent Blindness IRIS\u00AE Registry Grant, American Glaucoma Society Mentorship for the Advancement of Physician Scientists Award Obtained funding: N/A Financial Support : The sponsor or funding organization had no role in the design or conduct of this research. This research was funded in part by Research to Prevent

Keywords

Cataract
Cataract surgery
Glaucoma
IOP
IOP spike
IRIS Registry
Intraocular pressure
Intraocular pressure spike
Iris
Phacoemulsification

ASJC Scopus subject areas

Ophthalmology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ophtha.2024.01.022

Cite this

@article{b1d0028ff496475f97c174785ba72895,

title = "Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS{\textregistered} Registry (Intelligent Research in Sight)",

abstract = "Purpose: To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS{\textregistered} Registry (Intelligent Research in Sight). Design: Retrospective clinical cohort study. Participants: Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. Methods: Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. Main Outcome Measures: Incidence and OR of IOP spike. Results: We analyzed data from 1 191 034 eyes (patient 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, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. 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) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-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 early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.",

keywords = "Cataract, Cataract surgery, Glaucoma, IOP, IOP spike, IRIS Registry, Intraocular pressure, Intraocular pressure spike, Iris, Phacoemulsification",

author = "Lidder, {Alcina K.} and Vanner, {Elizabeth A.} and Chang, {Ta Chen} and Flora Lum and Rothman, {Adam L.}",

note = "Publisher Copyright: {\textcopyright} 2024 American Academy of Ophthalmology",

year = "2024",

month = jul,

doi = "10.1016/j.ophtha.2024.01.022",

language = "English (US)",

volume = "131",

pages = "780--789",

journal = "Ophthalmology",

issn = "0161-6420",

publisher = "Elsevier Inc.",

number = "7",

}

TY - JOUR

T1 - Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

AU - Lidder, Alcina K.

AU - Vanner, Elizabeth A.

AU - Chang, Ta Chen

AU - Lum, Flora

AU - Rothman, Adam L.

PY - 2024/7

Y1 - 2024/7

N2 - Purpose: To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS® Registry (Intelligent Research in Sight). Design: Retrospective clinical cohort study. Participants: Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. Methods: Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. Main Outcome Measures: Incidence and OR of IOP spike. Results: We analyzed data from 1 191 034 eyes (patient 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, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. 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) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-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 early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

AB - Purpose: To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS® Registry (Intelligent Research in Sight). Design: Retrospective clinical cohort study. Participants: Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. Methods: Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. Main Outcome Measures: Incidence and OR of IOP spike. Results: We analyzed data from 1 191 034 eyes (patient 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, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. 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) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-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 early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

KW - Cataract

KW - Cataract surgery

KW - Glaucoma

KW - IOP

KW - IOP spike

KW - IRIS Registry

KW - Intraocular pressure

KW - Intraocular pressure spike

KW - Iris

KW - Phacoemulsification

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DO - 10.1016/j.ophtha.2024.01.022

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AN - SCOPUS:85186581292

SN - 0161-6420

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JO - Ophthalmology

JF - Ophthalmology

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ER -

Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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