Timolol can control IOP spikes after phaco

Medically well-controlled glaucoma patients and patients with exfoliation syndrome may experience intraocular pressure (IOP) elevation shortly after cataract surgery. This can be controlled by the instillation of timolol maleate 0.5%, according to a report published in the January issue of Ophthalmology.

Hani Levkovitch-Verbin from the Goldschleger Eye Institute, Sheba Medical Center, Israel and colleagues from Tel-Aviv University, Israel conducted a prospective, randomized, double-masked clinical trial of 122 subjects with normal eyes, medically well-controlled glaucoma or exfoliation syndrome who had undergone uneventful phacoemulsification. Patients were randomly assigned to either an immediately postoperative drop of timolol maleate 0.5% or no treatment.

Changes in postoperative IOP differed significantly between glaucoma, exfoliation syndrome and normal eyes (r=0.005). IOP was significantly lower in the normal group (n=25) than in the glaucoma (n=18) and exfoliation syndrome (n=19) groups (r<0.001). Timolol significantly reduced postoperative IOPs over time in eyes with glaucoma but had no significant effect on either normal eyes or eyes with exfoliation syndrome.

Among eyes with glaucoma, 10 (55%) developed IOPs greater than 25 mmHg and five (28%) had IOPs greater than 30 mmHg. Among eyes with exfoliation syndrome, five (27%) had IOPs greater than 25 mmHg and two eyes (11%) had IOPs greater than 30 mmHg.

This research suggests that administering timolol immediately postoperatively can help prevent IOPs greater than 30 mmHg, although lower IOP elevations can still occur.