Cataract surgery reduces intraocular pressure but not posture-induced intraocular pressure changes in patients with angle-closure glaucoma

Pei-Yao Chang,Shu-Wen Chang,Hsin-Yu Weng,Jia-Kang Wang

doi:10.1038/s41598-019-50598-y

Pei-Yao Chang, Shu-Wen Chang + Show 2 more

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https://doi.org/10.1038/s41598-019-50598-y

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Abstract

Cataract surgery leads to a sustained decrease in sitting intraocular pressure (IOP) in patients with angle-closure glaucoma (ACG). The purpose of this study is to evaluate whether cataract surgery can also reduce postural IOP changes. We prospectively examined 106 eyes from 53 patients with narrow angles scheduled for phacoemulsification. IOP was measured in the sitting, supine, and lateral decubitus positions using an ICare rebound tonometer before and 1 week, 1 month, and 3 months postoperatively. The mean baseline IOP in the sitting and lateral decubitus positions was 17.9 ± 4.8 mmHg and 21.43 ± 6.44 mmHg, which significantly reduced to 13.52 ± 3.8 and 17.46 ± 3.62, respectively, 3 month postoperatively (p < 0.001). However, postural IOP change (lateral decubitus minus sitting) at 3 months postoperatively was not significantly different from that at the baseline (3.17 ± 2.63 vs. 3.53 ± 3.38 mmHg, p = 0.85). Postural IOP change was not associated with preoperative sitting IOP, anterior chamber depth, axial length, fixed pupil, or presence of glaucomatous optic neuropathy. Patients with higher preoperative IOP exhibited greater IOP reduction after cataract surgery in every posture (p < 0.0001). In conclusion, cataract surgery reduces IOP in all postures among patients with ACG; however, it does not reduce the magnitude of postural IOP change.

Highlights

Several studies have demonstrated a modest reduction in intraocular pressure (IOP) following cataract surgery in patients with primary open-angle glaucoma (POAG), ocular hypertension, or primary angle-closure glaucoma (PACG)[1,2]
Multiple regression analysis adjusted for age and sex revealed that posture-dependent IOP changes were not associated with preoperative sitting IOP, anterior chamber depth, axial length, fixed pupil, or presence of glaucomatous optic neuropathy (Table 4)
Previous studies evaluating postural IOP changes have primarily focused on open-angle glaucoma[5,7,10,11,12], whereas few have examined postural IOP changes in PACG patients

Summary

Introduction

Several studies have demonstrated a modest reduction in intraocular pressure (IOP) following cataract surgery in patients with primary open-angle glaucoma (POAG), ocular hypertension, or primary angle-closure glaucoma (PACG)[1,2]. Park J.H. et al.[6] reported cataract surgery lowered IOP in the sitting position as well as in the supine and lateral decubitus position in patients without glaucoma. In light of limited data regarding posture-dependent IOP changes after PHCE and intraocular lens (IOL) implantation for ACG, we conducted this study to evaluate whether cataract surgery can reduce postural IOP changes. Our second aim was to identify possible variables influencing posture-dependent IOP changes. These findings may provide a better understanding of IOP reduction following cataract surgery for PACG

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