Prävention des früh-postoperativen IOD-Anstiegs nach Phakoemulsifikation Vergleich verschiedener antiglaukomatöser Medikamente

Purpose. To compare the ocular hypotensive effect of different antiglaucomatous eye drops. Patients and methods. This double-blind, randomized study included 119 eyes of 119 patients without other ocular pathology undergoing standardized (one surgeon, Healon) small incision cataract surgery with foldable intraocular lens implantation.The patients were assigned to one of five groups: group 1:0.25% timolol in Gelrite (extended efficacy, n=23); group 2: 2% dorzolamide (n=24); group 3: combination of 0.5% timolol plus 2% dorzolamide (n=22); group 4: brimonidine (n=26); group 5: gentamicin (control, n=24). Intraocular pressure (IOP) was measured preoperatively and at 3±1,6±1,9±1,24±3, and 48±3 h postoperatively. Statistical interference was determined by nonparametric group comparisons using Wilcoxon's tests. Absolute values (static comparison) and intraindividual differences from preoperative measurements (dynamic comparisons) were evaluated. All p values should be regarded as descriptive values since they were not formally adjusted for multiplicity. A p value lower than 0.05 therefore indicates local statistical significance. Results. There were no differences between the groups with regard to age, phacoemulsification time, axial length, and preoperative IOP. A statistically significant IOP decrease was measured in group 1 at 24 (p=0.028) and 48 h (p=0.007) and in group 3 at 3 (p=0.001), 6 (p=0.001), 24 (p=0.001), and 48 h (p=0.001) after surgery. A statistically significant IOP increase occurred in group 4 at 3 (p=0.001), 6 (p=0.001), and 9 h (p=0.001) and in group 5 at 3 (p=0.001), 6 (p=0.001), 9 (p=0.001), and 24 h (p=0.002) postoperatively.Groups 1,2,and 3 demonstrated lower IOPs at different time points in comparison to groups 4 and 5. Furthermore, group 3 had lower lOPs at 3 h (compared to group 1) and at 6 h (compared to group 2) postoperatively. No statistical differences in IOP were found after 48 h. Conclusion. The results favor a combination of 0.5% timolol plus 2% dorzolamide to control postoperative IOP elevation.