Intra-ocular pressure fluctuation after cataract surgery in primary angle-closure glaucoma eyes medically controlled after laser iridotomy.

Abstract

To analyse the effect of cataract surgery on diurnal intra-ocular pressure (IOP) fluctuation in primary angle-closure glaucoma (PACG) eyes. Thirty-nine eyes of 24 patients with PACG scheduled for cataract surgery were enrolled to this prospective study. A record was made which included mean IOP measurement, anterior chamber depth (ACD), anterior chamber angle (ACA), number of antiglaucomatous medications, visual field analysis (mean deviation - MD and pattern standard deviation - PSD) and responses to the Glaucoma Quality of Life-15 (GQL-15) questionnaires. The eyes were re-evaluated at 2 and 3months of cataract surgery. IOP fluctuation was decreased from 4.58±2.07mmHg to 2.84±1.5mmHg (p<0.001). The decrease in mean IOP, the number of glaucoma eye drops required (p<0.001, p=0.012, respectively) and the increase in mean ACD, ACA grading and SITA-standard MD (p<0.001, p<0.001, and p=0.01, respectively) were statistically significant. The mean GQL-15 score was also improved (p<0.001). The change in IOP fluctuation correlated positively with the preoperative IOP fluctuation (r=0.56 p=0.00), the change in ACD (r=0.703, p<0.001) and the change in ACA (r=0.664, p<0.001). In multivariate analysis, preoperative IOP fluctuation and postoperative increase in ACD were significantly associated with a reduction in IOP fluctuation of an average of 1.1mmHg per unit change (p=0.00 and p=0.019, respectively). Cataract surgery in PACG provides the opportunity to address many pathologies with one intervention; improving vision, diminishing IOP, blunting IOP fluctuation, reducing need for medications, eliminating a narrow angle and improving GQL-15 scores.