Intraocular Pressure Spikes following Nd:YAG Laser Capsulotomy Journal of Current Glaucoma Practice, May-August 2017;11(2):63-66 63 JOCGP Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel 1 Asaf Achiron, 2 Uri Aviv, 3 Idan Hecht, 4 Michael Mimouni, 5 Yana Dzhanov, 6 Vitaly Man, 7 Assaf Hilely 8 Elisha Bartov, 9 Asaf Bar, 10 Zvia Burgansky-Eliash ABSTRACT Aim: The current treatment for posterior capsular opacifcation (PCO), neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, may lead to increased intraocular pressure (IOP). Our aim was to survey routines in the management of IOP spikes in Israel and to identify the rate of IOP spikes fol- lowing prophylactic apraclonidine treatment. Materials and methods: A survey questionnaire among oph- thalmologists and a retrospective registry review was used. Patients were administered apraclonidine 0.5% prior to capsulot- omy. The IOP was measured before and 1 hour postprocedure. Results: A total of 71% of responders (n = 45) routinely pre- scribe topical IOP-lowering medication and 82% routinely measure IOP before or after capsulotomy. The registry analysis included 87 eyes of 75 patients. Mean IOP decreased by 0.9 ± 3.3 mm Hg (p = 0.01, range: −6 to 10) following capsulotomy. No patient reached IOP values above 21 mm Hg following the procedure, with 3.4 and 1.1% of patients demonstrating an IOP elevation of more than 3 and 5 mm Hg respectively. No asso- ciation was found between number of laser shots, mean laser power, or comorbid conditions, such as diabetes, hypertension, or glaucoma status with posttreatment IOP. Conclusion: Most ophthalmologists surveyed routinely pre- scribe prophylactic IOP-lowering medication and measure IOP before or after capsulotomy. Mean IOP remained clinically stable following capsulotomy with prophylactic apracloni- dine instillation, and no patient reached IOP values above 21 mm Hg. Differences in laser delivery or comorbid conditions were not associated with posttreatment IOP. Considering that no patient demonstrated a clinically signifcant IOP spike 1 Resident, 2 Intern, 3,5 Students, 4,6,7 Residents, 8 Professor 9,10 Senior Doctor 1-3,5,8-10 Department of Ophthalmology, Edith Wolfson Medical Center, Holon and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 4 Department of Ophthalmology, Rambam Health Care Campus Haifa, Israel 6 Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel 7 Department of Ophthalmology, Kaplan Medical Center,Rehovot and Hebrew University-Hadassah Medical School, Jerusalem Israel Corresponding Author: Asaf Achiron, Resident, Department of Ophthalmology, Edith Wolfson Medical Center, Holon and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel, Phone:+97235028706, e-mail: achironasaf@gmail.com JOCGP 10.5005/jp-journals-10028-1225 RESEARCH ARTICLE following prophylactic apraclonidine instillation, perhaps routine measurement of IOP following primary Nd:YAG laser may be reserved for high-risk patients only. Clinical signifcance: In this work, we showed the prophylactic effect of apraclonidine 0.5% and suggest that measuring IOP after the procedure is necessary only in certain high-risk cases, possibly helping to reduce workload and patient waiting time and improving quality of service. Keywords: Apraclonidine, Cataract surgery, Intraocular pressure, Neodymium-doped yttrium aluminum garnet laser capsulotomy, Posterior capsular opacifcation. How to cite this article: Achiron A, Aviv U, Hecht I, Mimouni M, Dzhanov Y, Man V, Hilely A, Bartov E, Bar A, Burgansky-Eliash Z. Intraocular Pressure Spikes following Neodymium-doped Yttrium Aluminum Garnet Laser Capsulotomy: Current Prevalence and Management in Israel. J Curr Glaucoma Pract 2017;11(2):63-66. Source of support: Nil Confict of interest: None INTRODUCTION Posterior capsular opacifcation is the most common postoperative complication of cataract surgery with a cumulative 5-year incidence of 11.9%. 1 The treatment of choice for PCO is short pulsed Nd:YAG laser applied to the posterior capsule in order to create an opening in the visual axis. Although considered safe, it may result in retinal detachment, lens subluxation, and lens pitting. The most common complication is a transient increase in IOP, which may occur in 15 to 36% of patients who receive no prophylactic treatment. 2-6 This IOP spike may lead to additional injury in eyes with advanced glaucomatous optic nerve damage. 2 Several controlled studies from recent decades have investigated IOP-lowering agents and demonstrated suc- cessful control of IOP. 3-12 Routine practice and outcomes in real-life settings, however, have not been as thoroughly explored. Apraclonidine 0.5% is a common choice as a prophylactic treatment prior to laser capsulotomy. 8,13 Reported rates of IOP spikes above 5 mm Hg following prophylactic apraclonidine 0.5% and capsulotomy vary between 2 and 8.5%. 2,5,11,12 The purpose of this study was to survey routines in the management of post Nd:YAG laser capsulotomy IOP