Management of increased intraocular pressure after cataract extraction

We measured the change in intraocular pressure prospectively after extracapsular cataract extraction in 80 eyes after treatment with either pilocarpine gel, pilocarpine 4% solution, timolol 0.5% solution, or placebo. Intraocular pressure, pupil size, and anterior chamber cellular reaction were measured in a masked fashion on the first day after surgery. A significant increase in intraocular pressure was found in all groups postoperatively when compared with baseline values (P < .001). Eyes treated with pilocarpine gel had an average intraocular pressure increase of 4.2 ± 2.1 mm Hg (mean ± 1 S.E.), eyes treated with pilocarpine 4% eyedrops had an average increase of 9.8 ± 2.8 mm Hg, and eyes treated with timolol demonstrated an intraocular pressure increase of 8.25 ± 3.19. The intraocular pressure in untreated eyes (controls) increased by an average of 12.9 ± 2.7 mm Hg. Only the difference in intraocular pressure change between the eyes treated with pilocarpine gel and control eyes was statistically significant (P = .025). Postsurgical intraocular pressure exceeding 25 mm Hg was observed in three of 20 pilocarpine gel treated eyes (15%) and 11 of 20 control eyes (55%). Pilocarpine treatment was not associated with noticeable changes in intraocular inflammatory response, nor were significant ocular or systemic adverse reactions observed. A single administration of pilocarpine gel is effective in reducing increased intraocular pressure for the first 24 hours after extracapsular cataract extraction.