Kratz Assaf, Kornhauser Tom, Walter Eyal, Abuhasira Ran, Goldberg Ivan, Hadad Aviel
Department of Ophthalmology, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel.
Department of Ophthalmology, Shamir Medical Center (Assaf Harofeh), Be'er Ya'akov 70300, Israel.
Vision (Basel). 2025 Aug 28;9(3):73. doi: 10.3390/vision9030073.
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. To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM). 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 ( = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven. On day one, mean IOP was 14.0 ± 3.8 mmHg in the acetazolamide group versus 15.4 ± 3.8 mmHg in controls ( < 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference ( = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms. 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.
白内障手术后经常会出现短暂性眼压升高，这可能会引起担忧，尤其是在易患青光眼性损害或与眼压相关并发症的患者中。这些眼压峰值还与术后不适和头痛有关。尽管口服乙酰唑胺有已知的全身副作用，但仍经常被预防性使用。为了评估常规预防性口服乙酰唑胺在使用前房维持器（ACM）进行的无并发症超声乳化术后降低眼压方面的临床益处。在这项回顾性病例对照研究中，纳入了196例患者的196只眼。所有患者均接受了使用ACM的标准超声乳化术。患者术后要么接受口服乙酰唑胺（n = 98），要么不使用降低眼压的药物（n = 98）。术前以及术后第1天和第7天测量眼压。在第1天，乙酰唑胺组的平均眼压为14.0±3.8 mmHg，而对照组为15.4±3.8 mmHg（P<0.005）。到第7天，两组眼压相同（13.5 mmHg），无统计学显著差异（P = 0.95）。两组均无参与者报告头痛或严重不良反应，尽管乙酰唑胺组有10%的患者出现了轻度、短暂的全身症状。在使用ACM进行无并发症白内障手术的低风险患者中，常规使用口服乙酰唑胺仅能使眼压适度、短暂降低，且无明显临床益处。在这种情况下可能无需使用，不过对于高危个体可考虑针对性预防。
