Effect of Acetazolamide on Intraocular Pressure After Uneventful Phacoemulsification Using an Anterior Chamber Maintainer.

Background

Transient intraocular pressure (IOP) elevations frequently occur after cataract surgery and may raise concerns, especially in patients susceptible to glaucomatous damage or pressure-related complications. These IOP spikes have also been linked to postoperative discomfort and headache. Oral acetazolamide is often used prophylactically, despite its known systemic side effects.

Objectives

To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM).

Methods

In this retrospective case-control study, 196 eyes from 196 patients were included. All underwent standard phacoemulsification with an ACM. Patients either received oral acetazolamide postoperatively (n = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven.

Results

On day one, mean IOP was 14.0 ± 3.8 mmHg in the acetazolamide group versus 15.4 ± 3.8 mmHg in controls (p < 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference (p = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms.

Conclusions

In low-risk patients undergoing uneventful cataract surgery with ACM, routine use of oral acetazolamide yields only a modest, short-lived IOP reduction without evident clinical benefit. Its use may be unnecessary in this setting, though targeted prophylaxis could be considered for high-risk individuals.