Intraocular Pressure Changes Two-Six Hours, One Day, and One Week after Phacoemulsification Cataract Surgery and Implantation of Intraocular Lens

Document Type : Short Communication


1 Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran


Background: This study was conducted to evaluate the status of eye and intraocular pressure (IOP), two-six hours, one day, and one week after cataract surgery and implantation of the intraocular lens.
Methods: In a longitudinal study, 159 patients with senile cataracts were evaluated. Phacoemulsification surgery and intraocular lens (IOL) implantation in the capsular bag was done. The examinations including visual acuity measurement, slit-lamp examination, and measurement of IOP were done preoperatively, and three times after the surgery.
Results: The mean±standard deviation (range) age of the patients was 65.8 ± 10.5 (40-90) years. Preoperatively the IOP was 12.8 ± 3.5 mmHg, it increased to 20.8 ± 10.7, 2-6 hours after surgery (P < 0.0001), and then reached 13.7 ± 4.4 mmHg on the first postoperative day (P < 0.0001), then it decreased to 12.4 ± 2.9 mmHg one week after the surgery (P=0.02). The IOP was 28.6 ± 12.2 mmHg in eyes with epithelial edema which was significantly higher than those with stromal edema (17.3 ± 7.5 mmHg), and those without edema (16.5 ± 7.1 mmHg) 2-6 hours after surgery.
Conclusion: Since the IOP spike can damage the structure and function of the eye and cause pain, discomfort, and corneal edema that in turn prolongs recovery of vision, especially in those previously damaged, early postoperative examination on the same day after cataract surgery is strongly advised. IOP spikes can be managed safely by aqueous paracentesis without oral, parenteral, or topical drugs. Elevated IOP is more prevalent in eyes with postoperative epithelial corneal edema and in individuals whose cornea is totally edematous.


  1. Flaxman SR, Bourne RRA, Resnikoff S, Ackland P, Braithwaite T, Cicinelli MV, et al. Global causes of blindness and distance vision impairment 1990-2020: A systematic review and meta-analysis. Lancet Glob Health. 2017; 5(12):1221-34. doi: 10.1016/S2214-109X(17)30393-5.
  2. Sándor GL, Toth G, Szabo D, Szalai I, Lukács R, Pék A, et al. Cataract blindness in hungary. Int J Ophthalmol. 2020; 13(3):438-44. doi: 10.18240/ijo.2020.03.11. eCollection 2020.
  3. Wang W, Yan W, Fotis K, Prasad NM, Lansingh VC, Taylor HR, et al. Cataract surgical rate and socioeconomics: A global study. Invest Ophthalmol Vis Sci. 2016; 57(14):5872-81. doi: 10.1167/iovs.16-19894.
  4. Tognetto D, Brezin AP, Cummings AB, Malyugin BE, Evren Kemer O, Prieto I, et al. Rethinking elective cataract surgery diagnostics, assessments, and tools after the COVID-19 pandemic experience and beyond: Insights from the EUROCOVCAT group. Diagnostics (Basel). 2020; 10(12):1035. doi: 10.3390/diagnostics10121035.
  5. Singh K, Misbah A, Saluja P, Singh AK. Review of manual small-incision cataract surgery. Indian J Ophthalmol. 2017; 65(12):1281-8. doi: 10.4103/ijo.IJO_863_17.
  6. Signes Soler I, Javaloy J, Muñoz G, Moya T, Montalbán R, Albarrán C. Safety and efficacy of the transition from extracapsular cataract extraction to manual small incision cataract surgery in prevention of blindness campaigns. Middle East Afr J Ophthalmol. 2016; 23(2):187-94. doi: 10.4103/0974-9233.175890.
  7. Young CEC, Seibold LK, Kahook MY. Cataract surgery and intraocular pressure in glaucoma. Curr Opin Ophthalmol. 2020; 31(1):15-22. doi: 10.1097/ICU.0000000000000623.
  8. Zetterström C, Behndig A, Kugelberg M, Montan P, Lundström M. Changes in intraocular pressure after cataract surgery: Analysis of the Swedish National Cataract Register Data. J Cataract Refract Surg. 2015; 41(8):1725-9. doi: 10.1016/j.jcrs.2014.12.054.
  9. Moghimi S, Johari MK, Mahmoudi AR, Chen R, Mazloumi M, He M, et al. Predictors of intraocular pressure change after phacoemulsification in patients with pseudoexfoliation syndrome. Br J Ophthalmol. 2017; 101(3):283-9. doi: 10.1136/bjophthalmol-2016-308601.
  10. Melancia D, Abegão Pinto L, Marques Neves C. Cataract surgery and intraocular pressure. Ophthalmic Res. 2015; 53(3):141-8. doi: 10.1159/000377635. Epub 2015 Mar 7.
  11. Hayashi K, Yoshida M, Sato T, Manabe S-i, Yoshimura K. Intraocular pressure elevation after cataract surgery and its prevention by oral acetazolamide in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg. 2018; 44(2):175-81. doi: 10.1016/j.jcrs.2017.11.017.
  12. Weiner Y, Severson ML, Weiner A. Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy. J Cataract Refract Surg. 2015; 41(10):2081-91. doi: 10.1016/j.jcrs.2015.10.048.
  13. Tranos PG, Wickremasinghe SS, Hildebrand D, Asaria R, Mearza A, Ghazi Nouri S, et al. Same-day versus first-day review of intraocular pressure after uneventful phacoemulsification. J Cataract Refract Surg. 2003; 29(3):508-12. doi: 10.1016/s0886-3350(02)01649-8.
  14. Shingleton BJ, Rosenberg RB, Teixeira R, O'Donoghue MW. Evaluation of intraocular pressure in the immediate postoperative period after phacoemulsification. J Cataract Refract Surg. 2007; 33(11):1953-7. doi: 10.1016/j.jcrs.2007.06.039.
  15. Ahmed II, Kranemann C, Chipman M, Malam F. Revisiting early postoperative follow-up after phacoemulsification. J Cataract Refract Surg. 2002; 28(1):100-8. doi: 10.1016/s0886-3350(01)00994-4.
  16. Bilak S, Simsek A, Capkin M, Guler M, Bilgin B. Biometric and intraocular pressure change after cataract surgery. Optom Vis Sci. 2015; 92(4):464-70. doi: 10.1097/OPX.0000000000000553.
  17. Coban Karatas M, Sizmaz S, Altan Yaycioglu R, Canan H, Akova YA. Risk factors for intraocular pressure rise following phacoemulsification. Indian J Ophthalmol. 2013; 61(3):115-8. doi: 10.4103/0301-4738.99997.
  18. Güngör SG, Akman A, Kucukoduk A, Asena L, Simsek C, Yazici AC. Non-contact and contact tonometry in corneal Edema. Optom Vis Sci. 2016; 93(1):50-6. doi: 10.1097/OPX.0000000000000744.