Intraocular Pressure Spike after Uneventful Cataract Surgery in Primary Angle Closure Disease

Purpose: Purpose: To determine the incidence of and risk factors for intraocular pressure (IOP) spike after uneventful phacoemulsification in eyes with medically controlled primary angle closure disease (PACD).Methods: The medical records of medically controlled (preoperative IOP ≤ 21 mmHg) PACD patients who underwent uneventful phacoemulsification were reviewed retrospectively.IOP was measured 2-3 weeks before surgery and on postoperative day 1 (POD1).An IOP spike was defined as POD1 IOP > 25 mmHg.Generalized estimating equation models were used to determine factors associated with POD1 IOP spike, percentage IOP change, and absolute IOP change.Results: Among 309 eyes, POD1 IOP spike occurred in 20 (6.5%): 7 of 139 (5.0%) PAC eyes and 13 of 125 (10.4%)PAC glaucoma eyes; none of the 45 PAC suspect eyes were affected.Eyes with POD1 spike had higher preoperative IOP (p = 0.017), greater anti-glaucoma medication burden (p < 0.001), and thinner macular ganglion cell-inner plexiform layer thickness (p = 0.015).A greater number of preoperative anti-glaucoma medications (odds ratio [OR] = 2.632 to 2.633, p ≤ 0.013) and higher preoperative IOP (OR = 1.244, p = 0.015) were associated with POD1 IOP spike.Shallower preoperative anterior chamber depth (ACD; p ≤ 0.020), absence of laser peripheral iridotomy and argon laser peripheral iridoplasty (p ≤ 0.009), and lower preoperative IOP (p < 0.001) were associated with a larger percentage IOP increase.Younger age (p = 0.041), shallower preoperative ACD (p = 0.007), worse visual field mean deviation (p = 0.016), and worse pattern standard deviation (p = 0.001) were associated with greater absolute IOP change on POD1.Conclusions: The overall incidence of IOP spikes after uneventful cataract surgery in medically controlled PACD eyes was 6.5%.The risk was higher in eyes with a greater medication burden and higher preoperative IOP.