Rachel Xuan, Keith Ong

Purpose: To compare the incidence of intraocular pres- sure (IOP) elevation post cataract surgery between using shorter-acting tropicamide or longer-acting cyclopentolate.

Method: This retrospective, consecutive audit was con- ducted at a tertiary care centre in Sydney, Australia from November 2019 to March 2021. The two regimens used by ophthalmic surgeons in the department were
(A) phenylephrine 1% and cyclopentolate 2.5% or
(B) phenylephrine and tropicamide 1%. Electronic medi- cal records of 200 patients (Group A, n = 100; Group B, n = 100) were retrospectively accessed to record pre- and day 1 post-operative IOP of patients who had undergone uncomplicated cataract operations. Patients with a his- tory of glaucoma were excluded from the study.

Results: The percentage of patients with a higher IOP on day 1 post-op was 46% in Group A and 32% in Group
B. The mean post-operative IOP in Group A was higher than in Group B (14.4 ± 1.2 vs 13.1 ± 4.9 mmHg). A higher rise in mean IOP was detected in the operated eyes of patients in Group A compared to Group B (1.17 ± 1.1 mmHg, p = 0.038 vs -0.51 ± 0.9 mmHg, p = 0.28). A significant mean IOP elevation in patients with a clinically significant post-op IOP was detected in Group A (8.5 ± 4.4 mmHg, p = 0.0012).

Conclusions: Prolonged mydriasis and cycloplegia with cyclopentolate has a higher incidence of IOP rise at day 1 post-op compared to using tropicamide. This may be of low clinical relevance in a healthy eye but glaucomatous eyes and patients with poor circulation may be com- promised by post-op IOP rise.