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      Comparative Efficacy of Acetazolamide and Apraclonidine in the Control of Intraocular Pressure following Phacoemulsification


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          Purpose: The purpose of our study was to compare the effects of systemically administered acetazolamide and topical apraclonidine 0.5% in the control of intraocular pressure (IOP) following phacoemulsification of senile cataracts. Setting: The study was conducted on patients affected by cataract and followed at the Department of Ophthalmology. Methods: Seventy-eight eyes in 78 patients were selected. Twenty-six eyes were randomly assigned to postoperative treatment with topical apraclonidine 0.5%, 26 received oral acetazolamide and the remaining 26 received no hypotensive treatment (control group). Statistical analyses were performed mainly by means of analyis of variance. Results: IOPs measured 24 h after surgery were significantly (p = 0.01) lower in the apraclonidine group compared to the control group. Conclusions: Our double-blind prospective study conducted on patients randomly assigned to treatment with apraclonidine or acetazolamide shows that the former drug is undoubtedly effective in the prevention of IOP increases following phacoemulsification. IOPs recorded in patients treated with this drug were lower than those observed in the acetazolamide and the control groups. Considering the lower risk of toxicity associated with topical administration, apraclonidine 0.5% seems to be preferable to oral acetazolamide in this postoperative setting.

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          Most cited references5

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          Daily tonometric curves after cataract surgery.

          To evaluate daily tonometric curves after cataract surgery in patients with cataract only and in patients with cataract and glaucoma. 108 patients scheduled for cataract surgery were randomly allocated to two groups: 57 patients with cataract only (normal) and 51 with cataract and primary open angle glaucoma (POAG). All patients underwent extracapsular cataract extraction (ECCE) (manual technique with long wound), phacoemulsification (automated technique with short wound), or nucleus capture (manual technique with short wound). Intraocular pressure (IOP) was measured by Goldmann tonometry in all patients every 2 hours for 12 hours before the operation and at 1 and 6 months postoperatively. 79 patients completed the 6 month examination. ECCE resulted in greater reductions in IOP than the other procedures (ECCE: 27% and 36% in normal patients and those with POAG, respectively; nucleus capture: 20% and 31%, respectively; phacoemulsification: 19% and 22%, respectively). The fluctuations in IOP before and after surgery were not statistically significant. Cataract surgery in normal patients reduces IOP but does not eliminate fluctuations which are directly proportional to the IOP value and result partly from circadian rhythms. This important finding might influence our approach to treatment of patients with glaucoma.
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            First day follow up for routine phacoemulsification?

            To determine the postoperative morbidity on day 1 after uncomplicated phacoemulsification. A prospective study was performed on 100 otherwise healthy eyes after uncomplicated phacoemulsification and lens implant. Patients were examined on the first postoperative day and any deviation from a set postoperative protocol was recorded. Transient intraocular pressure rises of 30 mm Hg or greater were seen in three eyes. These all settled after a single dose of oral acetazolamide 250 mg. The results of this study reinforce the clinical impression that the need for day 1 routine follow up in this selected group of patients is questionable and probably unnecessary.
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              Intraindividual comparison of the effects of a fixed dorzolamide–timolol combination and latanoprost on intraocular pressure after small incision cataract surgery


                Author and article information

                S. Karger AG
                November 2006
                10 November 2006
                : 220
                : 6
                : 356-360
                2nd School of Medicine Sant. Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
                95860 Ophthalmologica 2006;220:356–360
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                : 09 February 2006
                : 26 May 2006
                Page count
                Figures: 1, Tables: 1, References: 12, Pages: 5
                Original Paper

                Vision sciences,Ophthalmology & Optometry,Pathology
                Intraocular pressure,Acetazolamide,Phacoemulsification,Apraclonidine


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