Abstract
BackgroundThe effect of cataract surgery on IOP in patients with primary open-angle glaucoma (POAG) is a subject of debate. We investigated the effect of cataract surgery by phacoemulsification on intraocular pressure (IOP) in patients with medically POAG .MethodsSeventy eyes of 40 POAG patients undergoing cataract surgery by phacoemulsification were retrospectively evaluated. All patients had their POAG medically controlled without prior glaucoma surgery. Baseline demographics and clinical characteristics were recorded. IOP and the number of glaucoma medications were evaluated before and for 1 year after cataract surgery. We analyzed IOP variations from baseline with a Student t-test for a paired sample. We used a Pearson correlation coefficient and linear regression to study the relation between IOP change from baseline and preoperative characteristics.ResultsOne year after phacoemulsification, IOP decreased by a mean 1.15 ± 3 mmHg (6.8 ± 18.1%) (P = 0.01) and the number of glaucoma medications remained unchanged with a difference of − 0.1 ± 0.43 (P = 0.09). Higher preoperative IOP was associated with a greater IOP decrease after 1 year of follow-up (P < 0.001). One and 7 days after cataract surgery, 12.9 and 4.2% of the eyes had IOP spikes > 30 mmHg, respectively. One year after cataract surgery, 75.7% of the POAG eyes maintained the same number of glaucoma medications while 17.1% had a decrease and 7.2% of the eyes required adding glaucoma medications.ConclusionCataract surgery by phacoemulsification in eyes with medically controlled POAG resulted at 1 year in a very small IOP decrease without a change in the number of glaucoma medications. A drop in IOP should not be expected after performing phacoemulsification alone in POAG patients.
Highlights
The effect of cataract surgery on intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) is a subject of debate
All patients were followed in the department of ophthalmology at Ambroise Paré Hospital and had POAG diagnosed based on clinical findings, visual field loss and/or retinal nerve fiber layer (RNFL) defects
8% of the POAG eyes had an IOP decrease > 5 mmHg; 5% of the eyes had an IOP increase > 5 mmHg, and 87% had stable IOP as defined as an IOP variation < 5 mmHg
Summary
The effect of cataract surgery on IOP in patients with primary open-angle glaucoma (POAG) is a subject of debate. We investigated the effect of cataract surgery by phacoemulsification on intraocular pressure (IOP) in patients with medically POAG. Glaucoma suspects and glaucoma patients, cataract surgery by phacoemulsification has been found to lead to a small decrease in intraocular pressure (IOP) [1,2,3,4,5,6,7]. The number of glaucoma medications varied from + 7% [22] to − 59% [23] after cataract surgery This may in be part explained by the variability of inclusion and exclusion criteria in these studies with some patients presenting with normal-tension glaucoma (NTG), uncontrolled glaucoma, or even patients with prior laser iridotomy, suggesting participation of angle closure mechanisms, and by the different study designs
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