{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T22:16:16Z","timestamp":1774908976234,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vision"],"abstract":"<jats:p>Background: Transient intraocular pressure (IOP) elevations frequently occur after cataract surgery and may raise concerns, especially in patients susceptible to glaucomatous damage or pressure-related complications. These IOP spikes have also been linked to postoperative discomfort and headache. Oral acetazolamide is often used prophylactically, despite its known systemic side effects. Objectives: To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM). Methods: In this retrospective case\u2013control study, 196 eyes from 196 patients were included. All underwent standard phacoemulsification with an ACM. Patients either received oral acetazolamide postoperatively (n = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven. Results: On day one, mean IOP was 14.0 \u00b1 3.8 mmHg in the acetazolamide group versus 15.4 \u00b1 3.8 mmHg in controls (p &lt; 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference (p = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms. Conclusions: In low-risk patients undergoing uneventful cataract surgery with ACM, routine use of oral acetazolamide yields only a modest, short-lived IOP reduction without evident clinical benefit. Its use may be unnecessary in this setting, though targeted prophylaxis could be considered for high-risk individuals.<\/jats:p>","DOI":"10.3390\/vision9030073","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:31:12Z","timestamp":1756373472000},"page":"73","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Acetazolamide on Intraocular Pressure After Uneventful Phacoemulsification Using an Anterior Chamber Maintainer"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1046-5779","authenticated-orcid":false,"given":"Assaf","family":"Kratz","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Kornhauser","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shamir Medical Center (Assaf Harofeh), Be\u2032er Ya\u2032akov 70300, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3223-4154","authenticated-orcid":false,"given":"Eyal","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ran","family":"Abuhasira","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7180-6202","authenticated-orcid":false,"given":"Ivan","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Glaucoma Unit, Sydney Eye Hospital, GPO Box 1614, Sydney, NSW 2001, Australia"},{"name":"Discipline of Ophthalmology, University of Sydney, Sydney, NSW 2006, Australia"},{"name":"Eye Associates, Sydney, NSW 2000, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7826-4549","authenticated-orcid":false,"given":"Aviel","family":"Hadad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Soroka University Medical Center, Ben Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.ophtha.2024.01.022","article-title":"Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS\u00ae Registry (Intelligent Research in Sight)","volume":"131","author":"Lidder","year":"2024","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/ICU.0000000000000545","article-title":"Early postoperative intraocular pressure elevation following cataract surgery","volume":"30","author":"Grzybowski","year":"2019","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jcrs.2013.08.048","article-title":"Risk factors for acute postoperative intraocular pressure elevation after phacoemulsification in glaucoma patients","volume":"40","author":"Slabaugh","year":"2014","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1093\/milmed\/usx113","article-title":"Risk factors for early intraocular pressure elevation after cataract surgery in a cohort of United States veterans","volume":"183","author":"Annam","year":"2018","journal-title":"Mil. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ophtha.2021.10.006","article-title":"Cataract in the adult eye preferred practice pattern","volume":"129","author":"Miller","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.1016\/j.jcrs.2007.06.039","article-title":"Evaluation of intraocular pressure in the immediate postoperative period after phacoemulsification","volume":"33","author":"Shingleton","year":"2007","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3129\/can j ophthalmol.06-086","article-title":"Risk factors for a postoperative intraocular pressure spike after phacoemulsification","volume":"42","author":"Ho","year":"2007","journal-title":"Can. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1177\/112067210601600409","article-title":"First day review after uncomplicated phacoemulsification: Is it necessary?","volume":"16","author":"Alwitry","year":"2006","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2177","DOI":"10.1016\/S0886-3350(02)01454-2","article-title":"Preventing intraocular pressure increase after phacoemulsification and the role of perioperative apraclonidine","volume":"28","author":"Kasetti","year":"2002","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jcrs.2004.07.024","article-title":"Medical control of intraocular pressure after phacoemulsification","volume":"31","author":"Dayanir","year":"2005","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1038\/eye.2000.198","article-title":"Randomised fellow eye comparison of the effectiveness of dorzolamide and apraclonidine on intraocular pressure following phacoemulsification cataract surgery","volume":"14","author":"Rainer","year":"2000","journal-title":"Eye"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/S0886-3350(13)80106-X","article-title":"Intraocular pressure following small-incision cataract surgery and polyHEMA posterior chamber lens implantation. A comparison between acetylcholine and carbachol","volume":"18","author":"Wedrich","year":"1992","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1038\/sj.eye.6701470","article-title":"Comparing the effects of travoprost and brinzolamide on intraocular pressure after phacoemulsification","volume":"19","author":"Ermis","year":"2005","journal-title":"Eye"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1016\/S0886-3350(99)00260-6","article-title":"Effect of dorzolamide and latanoprost on intraocular pressure after small incision cataract surgery","volume":"25","author":"Rainer","year":"1999","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/j.jcrs.2003.12.050","article-title":"Effect of topical brinzolamide 1% and brimonidine 0.2% on intraocular pressure after phacoemulsification","volume":"30","author":"Akman","year":"2004","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/S0886-3350(00)00706-9","article-title":"Intraindividual comparison of the effects of a fixed dorzolamide\u2013timolol combination and latanoprost on intraocular pressure after small incision cataract surgery","volume":"27","author":"Rainer","year":"2001","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1136\/bjo.79.9.809","article-title":"Intraocular pressure rise after phacoemulsification with posterior chamber lens implantation: Effect of prophylactic medication, wound closure, and surgeon\u2019s experience","volume":"79","author":"Lagreze","year":"1995","journal-title":"Br. J. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/112067210001000105","article-title":"A topical or oral carbonic anhydrase inhibitor to control ocular hypertension after cataract surgery","volume":"10","author":"Abbasoglu","year":"2000","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_19","first-page":"344","article-title":"A comparison of the effectiveness of dorzolamide and acetazolamide in preventing post-operative intraocular pressure rise following phacoemulsification surgery","volume":"43","author":"Zohdy","year":"1998","journal-title":"J. R. Coll. Surg. Edinb."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/0002-9394(77)90568-2","article-title":"The effect of acetazolamide on early increased intraocular pressure after cataract extraction","volume":"83","author":"Beidner","year":"1977","journal-title":"Am. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zamvar, U., and Dhillon, B. (2005). Postoperative IOP prophylaxis practice following uncomplicated cataract surgery: A UK-wide consultant survey. BMC Ophthalmol., 5.","DOI":"10.1186\/1471-2415-5-24"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/aos.14092","article-title":"Prophylactic treatment of intraocular pressure elevation after uncomplicated cataract surgery in nonglaucomatous eyes\u2014A systematic review","volume":"97","author":"Holm","year":"2019","journal-title":"Acta Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.ajo.2019.03.012","article-title":"Effect of topical hypotensive medications for preventing intraocular pressure increase after cataract surgery in eyes with glaucoma","volume":"205","author":"Hayashi","year":"2019","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.ophtha.2016.12.027","article-title":"Prophylactic effect of oral acetazolamide against intraocular pressure elevation after cataract surgery in eyes with glaucoma","volume":"124","author":"Hayashi","year":"2017","journal-title":"Ophthalmology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jcrs.2017.11.017","article-title":"Intraocular pressure elevation after cataract surgery and its prevention by oral acetazolamide in eyes with pseudoexfoliation syndrome","volume":"44","author":"Hayashi","year":"2018","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0886-3350(13)80054-5","article-title":"Using an anterior chamber maintainer to control intraocular pressure during phacoemulsification","volume":"20","author":"Blumenthal","year":"1994","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/S0886-3350(96)80214-8","article-title":"Use of the anterior chamber maintainer in anterior segment surgery","volume":"22","author":"Chawla","year":"1996","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"182","DOI":"10.3928\/1542-8877-20030501-03","article-title":"Comparison of intraocular pressure profiles during cataract surgery by phacoemulsification and extracapsular cataract extraction","volume":"34","author":"Grinbaum","year":"2003","journal-title":"Ophthalmic Surg. Lasers Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"23","DOI":"10.4103\/0301-4738.43047","article-title":"Nucleus management with Blumenthal technique: Anterior chamber maintainer","volume":"57","author":"Malik","year":"2009","journal-title":"Indian J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1136\/bjo.71.10.766","article-title":"Epidemiology of intraocular pressure in a population screened for glaucoma","volume":"71","author":"David","year":"1987","journal-title":"Br. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"757","DOI":"10.7326\/0003-4819-127-8_Part_2-199710151-00064","article-title":"Estimating causal effects from large data sets using propensity scores","volume":"127","author":"Rubin","year":"1997","journal-title":"Ann. Intern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1007\/s00417-022-05911-3","article-title":"Cataract surgery and IOP: A systematic review of randomised controlled trials","volume":"261","author":"Rodrigues","year":"2023","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/j.jcrs.2014.12.054","article-title":"Changes in intraocular pressure after cataract surgery: Analysis of the Swedish National Cataract Register data","volume":"41","author":"Behndig","year":"2015","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ajo.2022.09.006","article-title":"Intraocular pressure changes following stand-alone phacoemulsification: An IRIS Registry analysis","volume":"245","author":"Rothman","year":"2023","journal-title":"Am. J. Ophthalmol."}],"container-title":["Vision"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2411-5150\/9\/3\/73\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:11Z","timestamp":1760034851000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2411-5150\/9\/3\/73"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["vision9030073"],"URL":"https:\/\/doi.org\/10.3390\/vision9030073","relation":{},"ISSN":["2411-5150"],"issn-type":[{"value":"2411-5150","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,28]]}}}