Increased intraocular pressure on the first postoperative day following resident-performed cataract surgery

Purpose The aim of this study was to investigate the incidence of intraocular pressure (IOP) elevation after resident-performed cataract surgery and to determine variables, which influence postoperative day 1 (POD1) IOP. Methods In all, 1111 consecutive cataract surgeries performed only by training residents between 1 July 2001 and 30 June 2006 were included. Elevated IOP was defined as >= 23 mm Hg. Surgeries were classified according to the presence of POD1-IOP elevation. Fisher's exact test and Student t-test were used to compare both groups. Multivariate analyses using generalized estimating equations were performed to investigate predictor variables associated with POD1-IOP elevation. Results The average preoperative IOP was 16.0 +/- 3.2mmHg and the average POD1-IOP was 19.3 +/- 7.1 mm Hg, reflecting a significant increase in IOP (P<0.001, paired t-test). The incidence of POD1-IOP elevation >= 23 mm Hg was 22.0% (244/1111). Presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length were frequently encountered variables in the POD1-IOP elevation group (all P<0.05). Using a multivariate analysis, presence of glaucoma (P = 0.004, OR = 2.38; 95% confidence interval (95% CI) = 1.31-4.30), presence of ocular hypertension (P = 0.003, OR = 6.09; 95% CI = 1.81-20.47), higher preoperative IOP (P<0.001, OR = 3.73; 95% CI = 1.92-7.25), and longer axial length (P = 0.01, OR = 1.15; 95% CI = 1.03-1.29) were significant predictive factors for POD1-IOP elevation. Conclusions IOP elevation on the first postoperative day following resident-performed cataract surgery occurred frequently (22.0%). Increased early postoperative IOP was associated with presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length. Eye (2011) 25, 929-936; doi: 10.1038/eye.2011.93; published online 29 April 2011