Intraocular pressure change after sutureless phacoemulsification and foldable posterior chamber lens implantation

Purpose: To investigate the effect on intraocular pressure (IOP) of sutureless scleral and corneal tunnel Kelman phacoemulsification (KPE) with foldable posterior chamber intraocular lens (IOL) implantation. Setting: Jutes Stein Eye Institute, Los Angeles, California, USA. Methods: Preoperative and postoperative (1 and 6 weeks and 6 to 8 months) IOP measurements of 385 consecutive eyes having uneventful phacoemulsification and foldable posterior chamber IOL implantation were reviewed retrospectively. A subset of 193 eyes for which no IOP measurements were missing at any follow-up were analyzed separately. Results: Mean preoperative IOP was 15.8 mm Hg +/- 0.2 (+/-SE). It dropped postoperatively by 1.3 +/- 0.2 mm Hg at 1 week (P <.001), 2.5 +/- 0.2 mm Hg at 6 weeks (P <.001), and 2.2 +/- 0.2 mm Hg at 6 to 8 months (P <.001). Mean preoperative IOP for the subset without missing data was 16.0 +/- 0,3 mm Hg. It decreased by 1.1 +/- 0.3 mm Hg at 1 week (P <.001), 2.3 +/- 0.2 mm Hg at 6 weeks (P<.001), and 2.2 +/- 0,2 mm Hg at 6 to 8 months (P <.001). Wound construction (scleral versus corneal tunnel), anesthesia type (topical versus posterior orbital injection), the eye operated on, and patient age and sex did not significantly influence the postoperative pressure change. Patients with a preoperative diagnosis of glaucoma had significantly higher 1 week postoperative IOPs; however, the differences were statistically insignificant at 6 weeks and 6 to 8 months. Conclusion: Sutureless KPE with foldable posterior chamber IOL implantation lowered IOP by 1.1 to 2.5 mm Hg for the 6 months immediately following surgery. Glaucoma patients had a statistically significant initial rise in IOP at 1 week.