Incidence and Factors Associated With Postoperative Intraocular Pressure Spike Following Micropulse Transscleral Laser Therapy.

PRCIS

We investigated early IOP changes after MPTLT in glaucoma patients. Sixteen percent experienced transient IOP spikes at 1 hour. Alpha-2 adrenergic agonist use was associated with reduced IOP elevation and lower spike risk.

PURPOSE

To assess the incidence and contributing factors of postoperative intraocular pressure (IOP) spike following micropulse transscleral laser therapy (MPTLT).

PATIENTS AND METHODS

This prospective observational study included 80 eyes from 66 glaucoma participants undergoing MPTLT. An IOP spike was defined as an increase of 5 mm Hg or more at 1 hour postlaser compared with baseline. Demographic and clinical factors were assessed, and multivariable backward stepwise regression mixed-effect models were used to identify significant associations. The main outcome measures were the change in IOP at 1 hour (1 h IOP minus baseline IOP) and the occurrence of a 1-hour IOP spike.

RESULTS

The mean (SD) IOP change was -0.16 (6.40) mm Hg at 1 hour. Thirteen eyes (16%) met the criteria for the IOP spike, with the average change of 9.73 (5.57) mm Hg. Among these, 5 eyes (6% of all eyes) had an IOP rise of >10 mm Hg. All eyes with an IOP spike had an IOP return to baseline levels or lower at 18 hours. Pre-existing use of alpha-2 adrenergic (AA) agonists (coefficient -4.31, 95%

CI

-7.61 to -1.01, P =0.01) and higher baseline IOP (coefficient -0.12, 95%

CI

-0.23 to -0.004, P =0.042) were associated with less IOP elevation. Pre-existing use of AA agonists was identified as a protective factor for developing an IOP spike with an odds ratio of 0.20 (95%

CI

0.42 to 0.91, P =0.038).

CONCLUSIONS

One sixth of the patients experienced a postoperative IOP spike. Participants with pre-existing use of AA agonists tended to have a lower degree of IOP change and a lower IOP spike.