Transcript Effect of Eyelid Specula on Intraocular Pressure in

Effect of Eyelid Specula
on Intraocular Pressure
in Cataract Surgery
Gustave N. Alberti, M.D.1, Martha Schatz, M.D2.
•The authors have no financial interests in the material presented
•The materials presented here do not represent the views of the USAF
1 – San Antonio Military Medical Center/Combined Warfighter Refractive Surgery Center, San Antonio, TX
2- University of Texas Health Sciences Center, San Antonio, TX
Purpose
 To evaluate whether eyelid specula commonly used in
cataract surgery lead to changes in intraocular pressure (IOP).
 There are many aspects of cataract surgery that lead to
intraocular pressure elevation, including supine positioning,
the use of viscoelastics, and hydrostatic forces during
phacoemulsification.
 One study in a pediatric population looking at 77 eyes of 45
children showed a 4mmHg elevation in IOP after the Alfonso
newborn eyelid speculum placement.
 However there is no data looking at speculum use during
cataract surgery and their effect on IOP in adults. This
knowledge could help guide speculum choice in the future for
high-risk patients during ophthalmic surgery.
Methods
 38 patients undergoing routine cataract surgery under
topical anesthesia were recruited for this prospective
unmasked study.
 IOP measurements were performed before and after
eyelid speculum placement with a Tono-Pen Avia. The
first measurement took place once the patient had been
lying on the surgical table for approximately 10 minutes,
received a light benzodiazepine for comfort, and was
ready to commence prepping in preparation for cataract
surgery. The second measurement was performed
approximately 5 minutes later, after the patient had been
prepped and draped and the eyelid speculum had been
inserted.
 10 measurements were made and only measurements
displayed with a 95% confidence were recorded. The three
lid specula utilized included the Lieberman (31), Seibel 3D
(6), and Kratz-Barraquer (1).
Results
IOP pre- and post-speculum placement
Results
 The mean IOP prior to speculum placement in the OR
was 25 mmHg (SD 6.59)
 Mean IOP post speculum placement was 21.5 mmHg (SD
6.34)
 The difference of 3.5 mmHg was found to be
statistically significant at an alpha of 0.001 using a
paired student t-test.
 Average clinic IOP for these patients was 16.1 mmHg.
Conclusion
 Eyelid speculum placement does not seem to lead to increases in
intraocular pressure during routine cataract surgery, IOP was
actually lower after speculum placement.
 Interestingly, supine positioning and autoregulatory mechanisms
seemed to have the greatest effect on IOP changes. Three of the
patients had IOP above 40 in the OR despite having IOP of 18, 19,
and 22 in clinic, and no history of glaucoma. There was a 9mmHg
difference between supine positioning in the OR and
preoperative clinic IOP.
 While there are many factors leading to an increase in IOP during
cataract surgery, speculum use does not appear to be one of
them.
 Supine IOP measurements may prove useful in evaluating
glaucoma suspects with normal clinic IOP
References

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