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 less than .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.