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Hsu CH, Kakigi CL, Lin SC, Wang YH, Porco T, Lin SC. Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Nonglaucomatous Patients With Open Angles. Invest Ophthalmol Vis Sci 2015; 56:7807-7813. [PMID: 26650901 DOI: 10.1167/iovs.15-17926] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose To evaluate the relationship between lens position parameters and intraocular pressure (IOP) reduction after cataract surgery in nonglaucomatous eyes with open angles. Methods The main outcome of the prospective study was percentage of IOP change, which was calculated using the preoperative IOP and the IOP 4 months after cataract surgery in nonglaucomatous eyes with open angles. Lens position (LP), defined as anterior chamber depth (ACD) + 1/2 lens thickness (LT), was assessed preoperatively using parameters from optical biometry. Preoperative IOP, central corneal thickness, ACD, LT, axial length (AXL), and the ratio of preoperative IOP to ACD (PD ratio) were also evaluated as potential predictors of percentage of IOP change. The predictive values of the parameters we found to be associated with the primary outcome were compared. Results Four months after cataract surgery, the average IOP reduction was 2.03 ± 2.42 mm Hg, a 12.74% reduction from the preoperative mean of 14.5 ± 3.05 mm Hg. Lens position was correlated with IOP reduction percentage after adjusting for confounders (P = 0.002). Higher preoperative IOP, shallower ACD, shorter AXL, and thicker LT were significantly associated with percentage of IOP decrease. Although not statistically significant, LP was a better predictor of percentage of IOP change compared to PD ratio, preoperative IOP, and ACD. Conclusions The percentage of IOP reduction after cataract surgery in nonglaucomatous eyes with open angles is greater in more anteriorly positioned lenses. Lens position, which is convenient to compute by basic ocular biometric data, is an accessible predictor with considerable predictive value for postoperative IOP change.
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Affiliation(s)
- Chi-Hsin Hsu
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 2Department of Ophthalmology, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Caitlin L Kakigi
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
| | - Shuai-Chun Lin
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
| | - Yuan-Hung Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan 4Department of Medical Research, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Travis Porco
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California, United States
| | - Shan C Lin
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
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102
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Vahedian Z, Salmanroghani R, Fakhraie G, Moghimi S, Eslami Y, Zarei R, Mohammadi M. Pseudoexfoliation syndrome: Effect of phacoemulsification on intraocular pressure and its diurnal variation. J Curr Ophthalmol 2015; 27:12-5. [PMID: 27239568 PMCID: PMC4877725 DOI: 10.1016/j.joco.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in pseudoexfoliation (PEX) syndrome and its diurnal variation. Methods In this prospective, non-comparative, interventional case series, phacoemulsification was done for patients with PEX and concomitant visually significant cataract. Follow-up examinations including IOP measurement were done at postoperative day 1, week 1, month 1, month 3, and month 6. All IOP measurements were performed twice daily: once in the morning between 8 and 10 AM and the other in the evening between 6 and 8 PM. The minimum and maximum IOP and the mean IOP were recorded. IOP variation was defined as the difference between maximum and minimum pressures. Results Sixty-eight eyes of 68 patients were analyzed. The mean IOP dropped from 17.45 ± 3.32 mm Hg to 12.57 ± 1.58 mm Hg at 6 months. The minimum and maximum IOP dropped from 14.97 ± 3.46 mm Hg and 20.03 ± 3.39 to 11.53 ± 1.79 mm Hg and 13.01 ± 1.81 after 6 months, respectively. Diurnal IOP variation dropped from 5.06 ± 1.85 mm Hg (range 2–10) at baseline to 1.49 ± 0.93 mm Hg (range 0–4) at postoperative month 6 (p < 0.001 for all). This drop was not correlated with age and CCT, but was strongly correlated with baseline IOP variation (r = 0.847, p < 0.001). Conclusion Phacoemulsification without any additional intervention can be an attractive choice in managing the IOP and its diurnal variations in pseudoexfoliation patients, even with elevated IOP, who do not have advanced optic nerve damage.
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Affiliation(s)
- Zakieh Vahedian
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Roham Salmanroghani
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Fakhraie
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Moghimi
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yadollah Eslami
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Zarei
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Massood Mohammadi
- Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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103
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Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up. J Ophthalmol 2015; 2015:795357. [PMID: 26587282 PMCID: PMC4637500 DOI: 10.1155/2015/795357] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.
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104
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Legrand M, Blumen-Ohana E, Laplace O, Adam R, Akesbi J, Colas E, Nordmann J. Pression intraoculaire en postopératoire précoce de phakoémulsification chez le sujet normal et glaucomateux. J Fr Ophtalmol 2015; 38:633-8. [DOI: 10.1016/j.jfo.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/20/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
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Ngo WK, Tan CSH. Effect of bilateral sequential cataract extraction on intraocular pressure in non-glaucomatous Asian eyes. Br J Ophthalmol 2015; 100:560-4. [PMID: 26286823 DOI: 10.1136/bjophthalmol-2015-306713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 07/26/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS To determine the effect of cataract extraction on intraocular pressure (IOP) of both eyes in patients undergoing sequential cataract extractions. METHODS Retrospective review of 116 consecutive treatment-naive non-glaucomatous patients who underwent sequential cataract extractions of bilateral eyes. Baseline and postsurgical IOP measurements of eyes after cataract extraction were reviewed. Postsurgical IOP of the first surgical eye was compared with the IOP of the (unoperated) second eye. RESULTS Before surgery, there was no significant difference between the mean IOP of both eyes (15.4±2.6 mm Hg vs 15.2±2.5 mm Hg, p=0.22), and good correlation of presurgical IOP in both eyes was observed. After surgery, mean IOP in the first surgical eye decreased to 14.0±3.1 mm Hg at 1 month (p≤0.001). There was sustained and statistically significant (p<0.001) decrease in IOP in that eye for 2 years. Mean decrease in IOP ranged from 1.6 (8.6%) to 2.3 mm Hg (14.0%). In contrast, the IOP in the fellow (non-surgical) eye remained unchanged. Subsequently, cataract surgery to the fellow eye resulted in a decrease in IOP to a level similar to that of the previously operated eye, which was similarly sustained. Presurgical IOP was the only factor affecting the magnitude of decrease in IOP. CONCLUSIONS There is sustained decrease in IOP after cataract extraction in non-glaucomatous eyes. This decrease is of greater magnitude in eyes with higher presurgical IOP and is not affected by the type of surgery performed. The effect of IOP decrease after surgery is unilateral and does not affect the fellow eye.
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Affiliation(s)
- Wei Kiong Ngo
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore, Singapore
| | - Colin S H Tan
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore, Singapore
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Zetterström C, Behndig A, Kugelberg M, Montan P, Lundström M. Changes in intraocular pressure after cataract surgery: Analysis of the Swedish National Cataract Register Data. J Cataract Refract Surg 2015; 41:1725-9. [DOI: 10.1016/j.jcrs.2014.12.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/21/2014] [Accepted: 12/29/2014] [Indexed: 11/16/2022]
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Moghimi S, Abdi F, Latifi G, Fakhraie G, Ramezani F, He M, Lin SC. Lens parameters as predictors of intraocular pressure changes after phacoemulsification. Eye (Lond) 2015; 29:1469-76. [PMID: 26228292 DOI: 10.1038/eye.2015.141] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 06/12/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate intraocular pressure (IOP) change after cataract surgery in non-glaucomatous eyes with narrow and open angles (OAs) and its relation to novel lens parameters measured by anterior segment optical coherence tomography (AS-OCT). SETTING University affiliated hospital, Farabi Eye Hospital, Tehran, Iran. DESIGN Prospective interventional case series. METHODS In this prospective study, 85 non-glaucomatous eyes underwent phacoemulsification and lens implantation. Thirty-nine eyes had OAs and 46 eyes had narrow angles (NAs). IOP and biometric parameters were measured by AS-OCT preoperatively and 3 months after surgery. Change in IOP and its relation to biometric parameters, including lens vault (LV), anterior vault (AV), defined as the sum of the LV and the ACD, and relative LV (rLV), defined as the ratio of the LV to the AV, were evaluated. The main outcome measure was degree of IOP change after phacoemulsification. RESULTS Of the 85 patients included in the analysis, 35 were male and 50 were female with an overall mean age of 62.2 ± 8.9 years. The average IOP reduction was -4.95 ± 2.26 mm Hg, from a preoperative mean of 17.12 ± 2.47 mm Hg, at 3 months after cataract surgery. The amount of IOP reduction was significantly greater in the NA compared with the OA group. In multivariate linear regression analysis, preoperative IOP and AV were significantly associated with IOP decrease (all ≤ 0.03). CONCLUSION Cataract surgery results in IOP reduction in both OA and NA eyes. The amount of IOP reduction is related to AV.
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Affiliation(s)
- S Moghimi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran.,Koret Vision Center, University of California, San Francisco Medical School, San Francisco, CA, USA
| | - F Abdi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - G Latifi
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - G Fakhraie
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - F Ramezani
- Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran
| | - M He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - S C Lin
- Koret Vision Center, University of California, San Francisco Medical School, San Francisco, CA, USA
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108
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Short-Term Intraocular Pressure Elevations after Combined Phacoemulsification and Implantation of Two Trabecular Micro-Bypass Stents: Prednisolone versus Loteprednol. J Ophthalmol 2015; 2015:341450. [PMID: 26266045 PMCID: PMC4523671 DOI: 10.1155/2015/341450] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 11/20/2022] Open
Abstract
Objective. To compare the effects of prednisolone and of loteprednol after combined phacoemulsification and trabecular micro-bypass stent implantation (phaco-iStent).
Methods. Patients who underwent phaco-iStent between April 2013 and November 2014 were identified by retrospective chart review. Postoperatively, they received either prednisolone (n = 38) or loteprednol (n = 58). Baseline data was compared. Primary outcomes including intraocular pressure (IOP) and number of glaucoma medications (NGM) were analyzed at preoperative visit, postoperative day 1, weeks 1-2, weeks 3-4, and months 2-3. Results. Both groups had similar preoperative parameters (p > 0.05). The mean IOP spike occurred at postoperative weeks 1-2 with an increase of 2.21 ± 7.30 mmHg in the loteprednol group and 2.54 ± 9.28 mmHg in the prednisolone group. It decreased by weeks 3-4 in both groups and continued to improve at months 2-3. NGM showed significant reduction (p < 0.0001) after the surgery and remained stable in both groups. No significant group effect or time-group interaction in IOP and NGM evolution was detected (p > 0.05). The proportions of patients needing paracentesis were similar between the two groups. Conclusion. Similar early IOP elevations after combined phaco-iStent occurred with both prednisolone and loteprednol. Facilitated glucocorticoid infusion, altered aqueous humor outflow, and local inflammation may be contributing factors.
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109
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Zhang ML, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. Cochrane Database Syst Rev 2015; 2015:CD008671. [PMID: 26171900 PMCID: PMC4730948 DOI: 10.1002/14651858.cd008671.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cataract and glaucoma are leading causes of blindness worldwide, and their co-existence is common in elderly people. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of postoperative complications and compromise the success of either surgery. However, cataract surgery may independently lower intraocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. OBJECTIVES To assess the relative effectiveness and safety of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October 2014.We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to publications that cited the studies included in the review. We also contacted investigators and experts in the field to identify additional trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery (phacoemulsification) and any type of glaucoma surgery versus cataract surgery (phacoemulsification) alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration. MAIN RESULTS We included nine RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months. Seven trials were conducted in Europe, one in Canada and South Africa, and one in the United States. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies.Glaucoma surgery type varied among the studies: three studies used trabeculectomy, three studies used iStent® implants, one study used trabeculotomy, and two studies used trabecular aspiration. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference (MD) was -1.62 mmHg (95% confidence interval (CI) -2.61 to -0.64; 489 eyes) among six studies with data at one year follow-up. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95% CI -1.28 to -0.10; 301 eyes). Five studies showed that participants in the combined surgery group were about 50% less likely compared with the cataract surgery alone group to use one or more IOP-lowering medications one year postoperatively (risk ratio (RR) 0.47, 95% CI 0.28 to 0.80; 453 eyes). None of the studies reported the mean change in visual acuity or visual fields. However, six studies reported no significant differences in visual acuity and two studies reported no significant differences in visual fields between the two intervention groups postoperatively (data not analyzable). The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain (RR 1.13, 95% CI 0.15 to 8.25; 382 eyes). Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group (RR 1.06, 95% CI 0.34 to 3.35; 382 eyes). No study reported any vision-related quality of life data or cost outcome. Complications were reported at 12 months (two studies), 12 to 18 months (one study), and two years (four studies) after surgery. Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events. AUTHORS' CONCLUSIONS There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone. The evidence was uncertain in terms of complications from the surgeries. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (five years or more). Additional high-quality RCTs measuring clinically meaningful and patient-important outcomes are required to provide evidence to support treatment recommendations.
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Affiliation(s)
- Mingjuan Lisa Zhang
- Johns Hopkins University School of Medicine929 N. Wolfe St, Apt. 615BaltimoreMarylandUSA21205
| | | | - Henry Jampel
- Johns Hopkins University School of MedicineWilmer Eye Institute600 N. Wolfe StreetMaumenee B‐110BaltimoreMarylandUSA21287‐9205
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Malvankar-Mehta MS, Iordanous Y, Chen YN, Wang WW, Patel SS, Costella J, Hutnik CML. iStent with Phacoemulsification versus Phacoemulsification Alone for Patients with Glaucoma and Cataract: A Meta-Analysis. PLoS One 2015; 10:e0131770. [PMID: 26147908 PMCID: PMC4492499 DOI: 10.1371/journal.pone.0131770] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 06/05/2015] [Indexed: 11/28/2022] Open
Abstract
Background Minimally invasive glaucoma surgeries (MIGS) have attracted significant attention, as they have been reported to lower intra-ocular pressure (IOP) and have an excellent safety profile. The iStent is an example of a minimally invasive glaucoma device that has received particular attention due to its early and wide spread utilization. There is a growing body of evidence supporting its use at the time of phacoemulsification to help lower IOP. However, it is still not clear how much of the IOP lowering effect can be attributed to the iStent, the crystalline lens extraction or both when inserted concurrently at the time of phacoemulsification. This has been an important issue in understanding its potential role in the glaucoma management paradigm. Purpose To conduct a systematic review and meta-analysis comparing the IOP lowering effect of iStent insertion at the time of phacoemulsification versus phacoemulsification alone for patients with glaucoma and cataracts. Methods A systematic review was conducted utilizing various databases. Studies examining the IOP lowering effect of iStent insertion in combination with phacoemulsification, as well as studies examining the IOP lowering effect of phacoemulsification alone were included. Thirty-seven studies, reporting on 2495 patients, met the inclusion criteria. The percentage reduction in IOP (IOPR%) and mean reduction in topical glaucoma medications after surgery were determined. The standardized mean difference (SMD) was computed as a measure of the treatment effect for continuous outcomes taking into account heterogeneity. Fixed-effect and random-effect models were applied. Results A 4% IOP reduction (IOPR%) from baseline occurred following phacoemulsification as a solo procedure compared to 9% following an iStent implant with phacoemulsification, and 27% following 2 iStents implants with phacoemulsification. Compared with cataract extraction alone, iStent with phacoemulsification resulted in significant reduction in the post-operative IOP (IOPR%) (SMD = -0.46, 95% CI: [-0.87, -0.06]). A weighted mean reduction in the number of glaucoma medications per patient was 1.01 following phacoemulsification alone compared to 1.33 after one iStent implant with phacoemulsification, and 1.1 after 2 iStent implants with phacoemulsification. Compared to cataract extraction alone, iStent with cataract extraction showed a significant decrease in the number of glaucoma medications (SMD = -0.65, 95% CI: [-1.18, -0.12]). Funnel plots suggested the absence of publication bias. Conclusion Both iStent implantation with concurrent phacoemulsification and phacoemulsification alone result in a significant decrease in IOP and topical glaucoma medications. In terms of both reductions, iStent with phacoemulsification significantly outperforms phacoemulsification alone.
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Affiliation(s)
- Monali S. Malvankar-Mehta
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- * E-mail:
| | - Yiannis Iordanous
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Yufeng Nancy Chen
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Wan Wendy Wang
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | | | - John Costella
- Allyn & Betty Taylor Library, Natural Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Cindy M. L. Hutnik
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Pathology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa JM, Larrosa JM, Fea A, Lemij H, Gandolfi S, Schwenn O, Lorenz K, Samuelson TW. A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma. Ophthalmology 2015; 122:1283-93. [PMID: 25972254 DOI: 10.1016/j.ophtha.2015.03.031] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To assess the safety and effectiveness of the Hydrus Microstent (Ivantis, Inc, Irvine, CA) with concurrent cataract surgery (CS) for reducing intraocular pressure (IOP) in open-angle glaucoma (OAG). DESIGN Prospective, multicenter, randomized, single-masked, controlled clinical trial. PARTICIPANTS One hundred eyes from 100 patients 21 to 80 years of age with OAG and cataract with IOP of 24 mmHg or less with 4 or fewer hypotensive medications and a washed-out diurnal IOP (DIOP) of 21 to 36 mmHg. METHODS On the day of surgery, patients were randomized 1:1 to undergo CS with the microstent or CS alone. Postoperative follow-up was at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. Washout of hypotensive medications was repeated at 12 and 24 months. MAIN OUTCOME MEASURES Response to treatment was defined as a 20% or more decrease in washed out DIOP at 12 and 24 months of follow-up compared with baseline. Mean DIOP at 12 and 24 months, the proportion of subjects requiring medications at follow-up, and the mean number of medications were analyzed. Safety measures included change in visual acuity, slit-lamp observations, and adverse events. RESULTS The proportion of patients with a 20% reduction in washed out DIOP was significantly higher in the Hydrus plus CS group at 24 months compared with the CS group (80% vs. 46%; P = 0.0008). Washed out mean DIOP in the Hydrus plus CS group was significantly lower at 24 months compared with the CS group (16.9±3.3 mmHg vs. 19.2±4.7 mmHg; P = 0.0093), and the proportion of patients using no hypotensive medications was significantly higher at 24 months in the Hydrus plus CS group (73% vs. 38%; P = 0.0008). There were no differences in follow-up visual acuity between groups. The only notable device-related adverse event was focal peripheral anterior synechiae (1-2 mm in length). Otherwise, adverse event frequency was similar in the 2 groups. CONCLUSIONS Intraocular pressure was clinically and statistically significantly lower at 2 years in the Hydrus plus CS group compared with the CS alone group, with no differences in safety.
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Affiliation(s)
- Norbert Pfeiffer
- Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany.
| | | | | | - Jose M Larrosa
- Servicio de Oftalmología, University Hospital Miguel Servet, Zaragoza, Spain
| | - Antonio Fea
- Dipartimento di Scienze Chirugia, Clinica Oculistica, University of Torino, Torino, Italy
| | - Hans Lemij
- Glaucoma Service, Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Stefano Gandolfi
- Unita di Oftalmologia, Universita Degli Studi die Parma, Dipartimento di Scienze Biomediche, Biotecnologiche e Traslazionali, Clinica Oculistica, University of Parma, Parma, Italy
| | | | - Katrin Lorenz
- Department of Ophthalmology, Johannes Gutenberg-University, Mainz, Germany
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Abstract
PURPOSE To compare the efficacy of selective laser trabeculoplasty (SLT) in phakic and pseudophakic eyes in open-angle glaucoma and ocular hypertension. MATERIALS AND METHODS Charts of 28 pseudophakic eyes and 60 phakic eyes that underwent 360-degree SLT were retrospectively reviewed. Patients were examined at 1, 3, 6, and 12 months. Treatment success was defined as ≥20% intraocular pressure (IOP) reduction, with no additional medications, laser, or glaucoma surgery. Mean IOP change, mean percentage of IOP reduction, and success rates for phakic and pseudophakic eyes were compared. RESULTS Mean percentage of IOP reduction post-SLT at 1-, 3-, 6-, and 12-month visits were 21.4%, 25.8%, 24.8%, and 23.7%, respectively, in the pseudophakic group and 22.8%, 25.0%, 25.7%, and 21.2%, respectively, in the phakic group. Success rates ranged between 60% and 64% in the pseudophakic group and between 58% and 73% in the phakic group. No statistically significant differences in IOP change, percentage of IOP reduction, and success rate were seen between the groups at any of the post-SLT visits (P>0.05). CONCLUSIONS Application of 360-degree SLT seems to be an efficient and safe treatment option for the management of phakic and pseudophakic open-angle glaucoma and ocular hypertension.
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Kung JS, Choi DY, Cheema AS, Singh K. Cataract surgery in the glaucoma patient. Middle East Afr J Ophthalmol 2015; 22:10-7. [PMID: 25624668 PMCID: PMC4302462 DOI: 10.4103/0974-9233.148343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To summarize the role of cataract surgery in the glaucoma patient, in terms of the effect on intraocular pressure (IOP) as well as diagnostic and therapeutic considerations for those with both conditions. Recent evidence suggests that cataract extraction may produce a significant and sustained IOP reduction in individuals with open-angle glaucoma, ocular hypertension, and angle-closure glaucoma. Cataract removal may improve the practitioner's ability to interpret perimetric testing, and re-establishing perimetric and optic nerve imaging baselines is recommended after cataract surgery. The sequence of cataract surgery relative to glaucoma surgery impacts the likelihood of complications and surgical success. There are multiple benefits to perform cataract surgery prior to glaucoma surgery while cataract surgery after trabeculectomy increases the risk of subsequent filtration failure. As “minimally invasive glaucoma surgeries” continue to improve in terms of efficacy, there is an evolving role for combined cataract and glaucoma surgery in patients with early to moderate stages of glaucoma.
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Affiliation(s)
- Jennifer S Kung
- Byers Eye Institute, School of Medicine, Stanford University, California, USA
| | - Daniel Y Choi
- Byers Eye Institute, School of Medicine, Stanford University, California, USA
| | - Anjum S Cheema
- Byers Eye Institute, School of Medicine, Stanford University, California, USA
| | - Kuldev Singh
- Byers Eye Institute, School of Medicine, Stanford University, California, USA
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Chen DZ, Koh V, Sng C, Aquino MC, Chew P. Complications and outcomes of primary phacotrabeculectomy with mitomycin C in a multi-ethnic asian population. PLoS One 2015; 10:e0118852. [PMID: 25775362 PMCID: PMC4361399 DOI: 10.1371/journal.pone.0118852] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/17/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine the occurrence of intraoperative and postoperative complications up to three years after primary phacotrabeculectomy with intraoperative use of Mitomycin C (MMC) in primary open angle (POAG) and primary angle closure glaucoma (PACG) patients, and the effect of postoperative complications on surgical outcome. METHODS Retrospective review of 160 consecutive patients with POAG (n = 105) and PACG (n = 55), who underwent primary phacotrabeculectomy with MMC at the National University Hospital, Singapore, from January 1, 2008 to December 31, 2010. Data was collected using a standardized form that included patient demographic information, ocular characteristics and postoperative complications, including hypotony (defined as intraocular pressure < 6 mmHg), shallow anterior chamber (AC) and hyphema. RESULTS The mean age ± standard deviation (SD) of patients was 68.2 ± 8.2 years. No patient lost light perception during duration of follow-up. 77% of the postoperative complications occurred within the first month only. The commonest complications were hypotony (n = 41, 25.6%), hyphema (n = 16, 10.0%) and shallow AC (n = 16, 10.0%). Five patients (3.1%) required reoperation for their complications. Early hypotony (defined as hypotony < 30 days postoperatively) was an independent risk factor for surgical failure (hazard ratio [HR], 5.1; 95% CI, 1.6-16.2; p = 0.01). Hypotony with another complication was also a risk factor for surgical failure (p < 0.02). CONCLUSIONS Hypotony, hyphema and shallow AC were the commonest postoperative complications in POAG and PACG patients after phacotrabeculectomy with MMC. Most complications were transient and self-limiting. Early hypotony within the first month was a significant risk factor for surgical failure.
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Affiliation(s)
- David Z. Chen
- Department of Ophthalmology, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Victor Koh
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Chelvin Sng
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Maria C. Aquino
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Paul Chew
- Department of Ophthalmology, National University Health System, Singapore, Singapore
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115
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Melancia D, Abegão Pinto L, Marques-Neves C. Cataract surgery and intraocular pressure. Ophthalmic Res 2015; 53:141-8. [PMID: 25765255 DOI: 10.1159/000377635] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/02/2015] [Indexed: 11/19/2022]
Abstract
Cataract surgery is one of the most performed surgeries in the developed world. In addition to its significant impact on visual acuity, phacoemulsification has been hailed as a potential intraocular pressure (IOP)-lowering procedure. While current evidence suggests an overall significant and sustained decrease in IOP to exist after cataract surgery, the specific ocular characteristics that could help predict which patients are likely to benefit from this IOP-lowering effect remain unclear. This definition is important in glaucoma patients if this surgery is to be used in the treatment for this disease. Our review aims to summarize the literature on the subject, depicting possible mechanisms behind this IOP decrease, which type of patients are more likely to benefit from this surgery for IOP-lowering purposes and ultimately help optimizing disease management for the increasing number of patients with concomitant glaucoma and cataract.
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Affiliation(s)
- Diana Melancia
- Department of Pharmacology and Neurosciences, Lisbon University, Lisbon, Portugal
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116
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Walland MJ, Thomas R. Lens surgery to treat open-angle glaucoma: triumph of hope over (evidence-based) experience. J Cataract Refract Surg 2014; 41:247-8. [PMID: 25466484 DOI: 10.1016/j.jcrs.2014.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 11/26/2022]
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Rodríguez Uña I, Martínez-de-la-Casa JM, Pablo Júlvez L, Martínez Compadre JA, García Feijoo J, Belda Sanchís JI, Canut Jordana MI, Hernández-Barahona Palma J, Muñoz Negrete FJ, Urcelay Segura JL. Perioperative pharmacological management in patients with glaucoma. ACTA ACUST UNITED AC 2014; 90:274-84. [PMID: 25443206 DOI: 10.1016/j.oftal.2014.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED REVIEẂS AIM: When a phacoemulsification, a filtration surgery or a combined surgery are necessary, questions about the convenience of continuing certain antiglaucomatous drugs could appear. The aim of this review article is to unify criteria that will guide daily clinical practice and including the developing algorithms of action in the preoperative and postoperative periods of filtration surgery and/or cataract surgery. PROPOSED PROTOCOLS In the preoperative period of cataract surgery, the use of non-steroidal anti-inflammatory drugs is at the discretion of the surgeon, with the monodose presentation being recommended. The suspension of prostaglandines a fewdays before the surgery should be considered. Preservative-free drugs ensure a better recovery of the ocular surface (OS) after cataract surgery. Once all modifying factors of the intraocular pressure (IOP) have been removed, baseline IOP should be evaluated again, choosing preservative-free antiglaucomatous drugs when needed. The use of preservative-free ocular antihypertensive drugs and steroids in the preoperative period of glaucoma surgery reduces the risk of surgical failure. The interruption of prostaglandines is recommended. In the postoperative period of glaucoma surgery, steroids are the anti-inflammatory treatment of choice, the preservative-free ones being preferred. When reintroducing antiglaucomatous treatment, preservatives should be avoided to prevent scarring. The appropriate perioperative management of patients with glaucoma is essential to obtain a correct control of IOP, improve the situation of the OS, prevent complications and improve the result of the filtration surgery and cataract surgery. CONCLUSIONS this protocol aims to unify the different lines of action in order to decrease the incidence of adverse events and maximize the surgical outcome.
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Affiliation(s)
| | - J M Martínez-de-la-Casa
- Hospital Clínico San Carlos, IdISSC, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España.
| | - L Pablo Júlvez
- Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Miguel Servet, Zaragoza, España
| | | | - J García Feijoo
- Hospital Clínico San Carlos, IdISSC, Madrid, España; Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España
| | | | | | | | - F J Muñoz Negrete
- Red Temática de Investigación Cooperativa en Oftalmología (RETICS), Instituto de Salud Carlos III, Madrid, España; Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España
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Bussel II, Kaplowitz K, Schuman JS, Loewen NA. Outcomes of ab interno trabeculectomy with the trabectome by degree of angle opening. Br J Ophthalmol 2014; 99:914-9. [PMID: 25336577 PMCID: PMC4501175 DOI: 10.1136/bjophthalmol-2014-305577] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/21/2014] [Indexed: 11/12/2022]
Abstract
Aim To analyse ab interno trabeculectomy (AIT) with the trabectome and combined phacoemulsification with AIT (phaco-AIT) by Shaffer angle grade (SG). Methods Prospective study of AIT and phaco-AIT with narrow angles of SG≤2 versus open angles ≥3. Outcomes included intraocular pressure (IOP), medications, complications, secondary surgery and success (IOP <21 mm Hg and >20% reduction without further surgery). Exclusion criteria were missing preoperative data and <1 year follow-up. Results Of 671 included cases, at 1 year AIT SG≤2 (n=43) had an IOP reduction of 42% from 27.3±7.4 to 15.7±3.0 mm Hg (p<0.01) versus AIT SG≥3 (n=271) with an IOP reduction of 37% from 26.1±7.8 to 16.4±3.9 mm Hg (p<0.01). In phaco-AIT with SG≤2 (n=48), IOP was reduced 24% from 20.7±7.0 to 15.7±3.6 mm Hg (p<0.01) versus phaco-AIT with SG≥3 (n=309) with an IOP reduction of 25% from 22.6±6.4 to 17.0±3.4 mm Hg (p<0.01). There was no difference between SG≤2 and SG≥3 in reduction of IOP or medications, complications, secondary surgery and success rates (p>0.05). Conclusions SG≤2 is not associated with worse outcomes in AIT or phaco-AIT.
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Affiliation(s)
- I I Bussel
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - K Kaplowitz
- Department of Ophthalmology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - J S Schuman
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - N A Loewen
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Assessment of anterior chamber parameters after cataract surgery by Galilei dual Scheimpflug analyzer. Eye Contact Lens 2014; 41:40-3. [PMID: 25083777 DOI: 10.1097/icl.0000000000000063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the difference between anterior chamber parameters determined by the Galilei dual Scheimpflug analyzer after uneventful cataract surgery in normotensive eyes. METHODS In this study, 39 eyes of 30 patients (11 men and 19 women) who had uneventful cataract surgery with phacoemulsification were evaluated preoperatively, and at 1 month postoperatively with the Galilei. We investigated the measurements including anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), and the 3-, 5-, and 7-mm corneal thickness (CT) preoperatively and postoperatively. RESULTS The differences between ACD (P=0.01), ACA (P=0.07), ACV (P=0.01), and 7-mm CT (P=0.01), and intraocular pressure (P=0.03) were statistically significant after the first month of phacoemulsification. However, the differences between CCT (P=0.60), 3-mm CT (P=0.75), and 5-mm (P=0.17) CT were not statistically significant. CONCLUSIONS After the first month of cataract surgery, a significant increase was observed in ACD, ACV, ACA, and 7-mm CT parameters, which were practically determined by a new noncontact Scheimpflug imagining system.
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121
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Lens-based glaucoma surgery: Using cataract surgery to reduce intraocular pressure. J Cataract Refract Surg 2014; 40:1255-62. [DOI: 10.1016/j.jcrs.2014.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 01/13/2014] [Indexed: 11/19/2022]
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122
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Sawada A, Yamada H, Yamamoto Y, Yamamoto T. Intraocular pressure alterations after visual field testing. Jpn J Ophthalmol 2014; 58:429-34. [PMID: 25001008 DOI: 10.1007/s10384-014-0332-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine whether intraocular pressure (IOP) is significantly altered after visual field (VF) testing in eyes with open-angle glaucoma (OAG). METHODS A prospective clinical trial of 106 OAG patients who had not had any previous surgical interventions. IOP was measured with a non-contact tonometer and refractive error with an auto refractometer. The measurements were made before and immediately after the VF test of the first eye (OD) and the second eye (OS). RESULTS The baseline refractive error (spherical equivalent) was -4.13 ± 3.61 diopters (D) OD and -4.05 ± 3.63 D OS. The average VF testing time was 7.5 ± 1.4 min OU. The average baseline IOP was 12.8 ± 2.9 mmHg OD and 12.6 ± 2.8 mmHg OS. After the VF testing OD, the average IOP decreased significantly to 12.3 ± 2.6 mmHg (P = 0.001), but the IOP (12.5 ± 2.6 mmHg) OS was not significantly unchanged (P = 0.190). Following the VF testing OS, the IOP OD was 12.2 ± 2.6 mmHg (P = 0.252) and OS was 12.4 ± 2.7 mmHg (P = 0.487). An elevation of ≥2 mmHg in the IOP after the VF testing was found in 2.8 % of the right eyes and 0.9 % of the left eyes. The refractive error was not significantly changed after the VF testing. Multivariate analysis showed statistically significant correlations between the IOP decrease after the VF testing and the baseline IOP (P = 0.000) and the central corneal thickness (P = 0.034). CONCLUSIONS In the majority of eyes with OAG, VF testing did not lead to an increase in the IOP. The amount of IOP reduction after VF testing is significantly correlated with the baseline IOP and central corneal thickness.
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Affiliation(s)
- Akira Sawada
- Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan,
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Abstract
PURPOSE OF REVIEW To examine the current literature covering the long-term effect of cataract extraction on intraocular pressure (IOP). RECENT FINDINGS As a result of the high rate of cataract surgery, the impact on IOP continues to be the subject of multiple studies in different populations. Recent publications include those that distinguish patients with open angles from those with more narrow angles, as well as prospective analyses that address the impact of regression to the mean and other types of bias on the effect of postoperative IOP lowering. SUMMARY There are sufficient data to suggest that cataract surgery provides a lowering effect on IOP in the long term. This effect appears to be proportional to preoperative IOP. Eyes with higher preoperative IOP have the greatest average lowering, whereas eyes with IOP in the lower range of statistically normal tend to have an IOP that is unchanged from baseline or even higher following cataract surgery. In patients with narrow angles, the IOP-lowering effect appears to also be proportional to the degree of anterior chamber deepening induced by cataract surgery.
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Lack of a Visible Outcome Marker Fuels the Perfect Storm of Dr Singh's Editorial. Ophthalmology 2014; 121:e12. [DOI: 10.1016/j.ophtha.2013.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/18/2013] [Indexed: 11/20/2022] Open
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126
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Netland PA. Cataract surgery in glaucoma patients: how much benefit? Am J Ophthalmol 2014; 157:1-3. [PMID: 24330911 DOI: 10.1016/j.ajo.2013.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 09/20/2013] [Accepted: 09/21/2013] [Indexed: 10/25/2022]
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127
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Slabaugh MA, Bojikian KD, Moore DB, Chen PP. The effect of phacoemulsification on intraocular pressure in medically controlled open-angle glaucoma patients. Am J Ophthalmol 2014; 157:26-31. [PMID: 24182743 DOI: 10.1016/j.ajo.2013.08.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate intraocular pressure (IOP) after phacoemulsification in patients with medically controlled open-angle glaucoma (OAG), and examine the association of biometric variables to IOP changes. DESIGN Retrospective case series. METHODS Open-angle glaucoma patients without prior incisional glaucoma surgery undergoing phacoemulsification by a single surgeon between January 1997 and October 2011 were evaluated. Patient charts were reviewed to obtain demographic information, preoperative glaucoma medications, severity and treatment measures, and preoperative and postoperative IOP. RESULTS A total of 157 eyes (157 patients) were included in the study. The average preoperative IOP of 16.3 ± 3.6 mm Hg decreased to 14.5 ± 3.4 mm Hg at 1 year (P < .001). Sixty eyes (38%) required additional medications or laser for IOP control within the first year postoperatively, or had a higher IOP at postoperative year 1 without medication change. Among eyes without postoperative medication changes (n = 102), higher preoperative IOP (P < .001), older age (P = .006), and deeper anterior chamber depth (P = .015) were associated with lower postoperative IOP. CONCLUSIONS Phacoemulsification resulted in a small average decrease in IOP in patients with OAG. A sizeable proportion of medically controlled glaucoma patients with open angles undergoing phacoemulsification experienced an increase in IOP or required more aggressive treatment to control IOP postoperatively.
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Affiliation(s)
- Mark A Slabaugh
- Department of Ophthalmology, University of Washington, Seattle, Washington.
| | - Karine D Bojikian
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Daniel B Moore
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Philip P Chen
- Department of Ophthalmology, University of Washington, Seattle, Washington
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Falke K, Krüger P, Hosten N, Zimpfer A, Guthoff R, Langner S, Stachs O. Experimental differentiation of intraocular masses using ultrahigh-field magnetic resonance imaging--a case series. PLoS One 2013; 8:e81284. [PMID: 24349051 PMCID: PMC3857191 DOI: 10.1371/journal.pone.0081284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/20/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The case reports presented here were compiled to demonstrate the potential for improved diagnosis and monitoring of disease progress of intraocular lesions using ultrahigh-field magnetic resonance microscopy (MRM) at 7.1 Tesla. METHODS High-resolution ex vivo ocular magnetic resonance (MR) images were acquired on an ultrahigh-field MR system (7.1 Tesla, ClinScan, Bruker BioScan, Germany) using a 2-channel coil with 4 coil elements and T2-weighted turbo spin echo (TSE) sequences of human eyes enucleated because of different intraocular lesions. Imaging parameters were: 40×40 mm field of view, 512×512 matrix, and 700 µm slice thickness. The results were correlated with in vivo ultrasound and histology of the enucleated eyes. RESULTS Imaging was performed in enucleated eyes with choroidal melanoma, malignant melanoma of iris and ciliary body with scleral perforation, ciliary body melanoma, intraocular metastasis of esophageal cancer, subretinal bleeding in the presence of perforated corneal ulcer, hemorrhagic choroidal detachment, and premature retinopathy with phthisis and ossification of bulbar structures. MR imaging allowed differentiation between solid and cystic tumor components. In case of hemorrhage, fluid-fluid levels were identified. Melanin and calcifications caused significant hypointensity. Microstructural features of eye lesions identified by MRM were confirmed by histology. CONCLUSION This study demonstrates the potential of MRM for the visualization and differential diagnosis of intraocular lesions. At present, the narrow bore of the magnet still limits the use of this technology in humans in vivo. Further advances in ultrahigh-field MR imaging will permit visualization of tumor extent and evaluation of nonclassified intraocular structures in the near future.
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Affiliation(s)
- Karen Falke
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Paul Krüger
- Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Greifswald, Germany
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Greifswald, Germany
| | - Annette Zimpfer
- Institute of Pathology, University of Rostock, Rostock, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Sönke Langner
- Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Greifswald, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
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Ahuja Y, Ma Khin Pyi S, Malihi M, Hodge DO, Sit AJ. Clinical results of ab interno trabeculotomy using the trabectome for open-angle glaucoma: the Mayo Clinic series in Rochester, Minnesota. Am J Ophthalmol 2013; 156:927-935.e2. [PMID: 23954209 DOI: 10.1016/j.ajo.2013.06.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine outcomes of ab interno trabeculotomy for treatment of open-angle glaucoma (OAG). DESIGN Retrospective interventional single-surgeon, single-center case series. METHODS Data were collected from 246 patients undergoing ab interno trabeculotomy between September 1, 2006, and December 1, 2010, with 3 months' follow-up or longer. Kaplan-Meier analysis was performed using Criteria A (postoperative intraocular pressure [IOP] ≤21 mm Hg or ≥20% reduction from preoperative IOP) and Criteria B (IOP ≤18 mm Hg and ≥20% reduction in IOP). Failure included increased glaucoma medications or subsequent surgery. Failure risk factors were identified using Cox proportional hazards ratio (HR). RESULTS Of 88 cases of ab interno trabeculotomy-only and 158 cases of ab interno trabeculotomy with cataract extraction, the retention rate was 70% for 1 year and 62% for 2 years. Preoperative mean IOP was 21.6 ± 8.6 mm Hg; the number of glaucoma medications was 3.1 ± 1.1. At 24 months postoperatively, mean IOP was reduced 29% to 15.3 ± 4.6 mm Hg (P < 0.001) and the number of glaucoma medications was reduced 38% to 1.9 ± 1.3 (P < 0.001) with a success rate of 62% (95% CI, 56%-68%) using Criteria A and 22% (95% CI, 16%-29%) using Criteria B. Failure risk factors using Criteria A included primary OAG (HR 3.14, P < 0.01, 95% CI, 1.91-5.17) and past argon laser trabeculoplasty (HR 1.81, P < 0.01, 95% CI, 1.18-2.77). Using Criteria B, the HR for pseudoexfoliative glaucoma was 0.43 (P < 0.01, 95% CI 0.27-0.67). Of the cases, 66 (26.8%) required subsequent surgery on an average of 10 months (2 days to 3.2 years) after ab interno trabeculotomy. CONCLUSIONS For criteria involving IOP ≤18 mm Hg, the 24-month survival of ab interno trabeculotomy is low. This surgery is appropriate for patients requiring a target IOP of 21 mm Hg or above.
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Affiliation(s)
- Yachna Ahuja
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
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Guan H, Mick A, Porco T, Dolan BJ. Preoperative factors associated with IOP reduction after cataract surgery. Optom Vis Sci 2013; 90:179-84. [PMID: 23292045 DOI: 10.1097/opx.0b013e31827ce224] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To identify preoperative factors associated with postoperative intraocular pressure (IOP) reduction after phacoemulsification cataract extraction in patients with primary open-angle glaucoma (POAG) treated at a Veterans Affairs Medical Center. METHODS Examination records of 103 eyes of 75 patients with POAG who underwent uncomplicated phacoemulsification cataract extraction were reviewed. Preoperative data collected for analysis included IOP, number of glaucoma medications, spherical equivalent refractive errors, central corneal thickness, anterior chamber depth, and axial length. The IOPs measured 3 to 6 months after surgery were used to calculate the change in IOP after cataract extraction. Statistical analysis was performed to identify preoperative factors associated with postoperative IOP reduction. RESULTS The mean postoperative IOP reduction was 1.8 ± 3.5 mm Hg (p < 0.001). Seventy-four percent of eyes (76 of 103) had decreased IOP after cataract surgery. Eight percent of eyes (8 of 103) had no change in IOP. Eighteen percent of eyes (19 of 103) had increased IOP after cataract surgery. The mean preoperative IOPs for eyes with increased, same, and decreased postoperative IOPs were 12 ± 2.2 mm Hg, 14.0 ± 2.3 mm Hg, and 16.4 ± 3.1 mm Hg, respectively. The mean postoperative IOPs change for eyes with increased and decreased postoperative IOPs were +2.7 ± 2.1 mm Hg and -3.7 ± 2.5 mm Hg, respectively. Preoperative IOP was the only preoperative factor significantly associated with postoperative IOP reduction (p < 0.001). CONCLUSIONS Preoperative IOP was the only factor significantly associated with postoperative IOP reduction after cataract surgery in POAG patients. A higher preoperative IOP was strongly associated with a greater postoperative IOP reduction. Patients with low preoperative IOPs tended to have minimal reduction or even a mild increase in postoperative IOPs. These findings have important implications when considering combined cataract extraction and filtration surgery for POAG patients.
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Affiliation(s)
- Huan Guan
- Department of Veteran Affairs Medical Center Miami, Miami, Florida 33125, USA.
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131
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Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol 2013; 156:89-94.e1. [PMID: 23628350 DOI: 10.1016/j.ajo.2013.02.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/05/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the ocular biometric parameters associated with intraocular pressure (IOP) reduction after phacoemulsification. DESIGN Prospective, observational case series. METHODS The study included 999 patients who had undergone uncomplicated phacoemulsification. IOP and ocular biometric parameters were checked preoperatively and 3 months postoperatively using anterior segment optical coherence tomography, optical biometry, and ultrasonic biomicroscopy. The relationship between IOP change and the parameters, including preoperative IOP, anterior chamber depth, axial length, angle opening distance at 500 μm, anterior chamber area, corneal thickness, lens thickness, and iris thickness at 750 μm, was evaluated. RESULTS The mean patient age was 67.1 ± 4.3 years. The average change in IOP was -1.6 mm Hg (-11.8%). In univariate analysis, axial length, corneal thickness, and iris thickness were not significantly associated with IOP reduction. However, preoperative IOP, anterior chamber depth, angle opening distance, anterior chamber area, and lens thickness were significantly associated with IOP change (P < .05). Furthermore, changes in anterior chamber depth (standardized coefficient beta [B] = -0.082), angle opening distance (B = -0.095), and anterior chamber area (B = -0.380) were more strongly correlated with IOP change than were preoperative factors (B = -0.078, B = -0.071, and B = -0.067, respectively). In multivariate analysis, preoperative IOP, lens thickness, angle opening distance change, and anterior chamber area change were significantly associated with IOP change (P < .005). CONCLUSION In addition to preoperative IOP and lens thickness, parameters such as changes in anterior chamber area and angle opening distance were significantly associated positively with reduced IOP after phacoemulsification.
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Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D, García-Vidal SE, Fernández-Pérez C, García-Sánchez J, García-Feijoó J. Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract. Br J Ophthalmol 2013; 97:1250-5. [PMID: 23603758 DOI: 10.1136/bjophthalmol-2012-302394] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the mid-term efficacy and safety of the GTS-400-iStent combined with phacoemulsification in patients with cataract and open-angle glaucoma (OAG) or ocular hypertension (OHT). METHODS Prospective, non-comparative, uncontrolled, interventional case series study. Subjects underwent phacoemulsification and two GTS-400 implantation. Efficacy outcomes: intraocular pressure (IOP) and antiglaucoma medications. Safety outcomes: complications, best-corrected visual acuity and endothelial cell count (ECC). Follow-up was 1 year. RESULTS 20 patients were enrolled (mean age: 75.1 ± 8.6 years). Mean medicated baseline IOP was 19.95 ± 3.71 mm Hg and 26 ± 3.11 mm Hg without medication. Mean final IOP was 16.75 ± 2.24, determining a final IOP decrease of 35.68% (9.42 ± 3 mm Hg; p<0.001), from baseline washout IOP. Mean number of medications fell from 1.3 ± 0.66 to 0.3 ± 0.57 (P<0.001). 75% of patients were off medications at one year. Mean ECC decreased from 2289.64 ± 393.5 cells/mm(2) to 1986.95 ± 520.58 cells/mm(2). CONCLUSIONS Combined cataract surgery with implantation of GTS-400-iStent seems to be an effective and safe procedure.
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Affiliation(s)
- Pedro Arriola-Villalobos
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), , Madrid, Spain
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133
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Kronberg BP, Rhee DJ. Anterior segment imaging and the intraocular pressure lowering effect of cataract surgery for open and narrow angle glaucoma. Semin Ophthalmol 2013; 27:149-54. [PMID: 23163269 DOI: 10.3109/08820538.2012.708810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anterior segment imaging modalities including anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) are increasingly widespread, and can quantify several parameters of the anterior segment, such as anterior chamber depth and angle anatomy. These parameters are important to assess, particularly in patients with forms of narrow angle glaucoma. In many cases of open and narrow angle glaucoma, cataract extraction has been shown to result in favorable modification of these parameters, and a lasting decrease in intraocular pressure. Anterior segment imaging has the ability to enable the development of predictive models regarding the potential intraocular pressure lowering effect of cataract extraction in a given individual.
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134
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Timely cataract surgery for improved glaucoma management. J Cataract Refract Surg 2013; 38:1709-10. [PMID: 22999597 DOI: 10.1016/j.jcrs.2012.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Indexed: 11/22/2022]
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135
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Ansari E. IOP Maintenance in SLT-treated Eyes following Subsequent Phacoemulsification and IOL. J Curr Glaucoma Pract 2013; 7:17-8. [PMID: 26997775 PMCID: PMC4741128 DOI: 10.5005/jp-journals-10008-1131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 12/19/2012] [Indexed: 11/23/2022] Open
Abstract
To assess whether the intraocular pressure (IOP) in selective laser trabeculoplasty (SLT)-treated eyes is maintained following subsequent phacoemulsification and lens implant (phaco + IOL). Retrospective single center review of 45 eyes of 35 patients who had open angle glaucoma (OAG), successfully treated by SLT by the same surgeon (EA), and then had routine phaco + IOL by same surgeon (EA). The main outcome measures were baseline (SLT-treated) IOP and IOP at 3, 6 and 12 months following subsequent routine phaco + Intraocular lens (IOL). Secondary outcome measures were visual acuity pre- and post (phaco + IOL) and any complications. The study found that IOP reduction with SLT is not significantly affected by subsequent phaco + IOL in patients with OAG. How to cite this article: Ansari E. IOP Maintenance in SLT-treated Eyes following Subsequent Phacoemulsification and IOL. J Current Glau Prac 2013;7(1):17-18.
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Affiliation(s)
- Ejaz Ansari
- Consultant Ophthalmic Surgeon, Maidstone and Tunbridge Wells NHS Trust, Maidstone United Kingdom; Reader, University of Kent at Canterbury, Kent United Kingdom
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136
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Choi WS, Shin YJ, Kim HK, Yi K. Comparison of Intraocular Pressure after Cataract Surgery According to Incisional Techniques. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Won Seok Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Joo Shin
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ha Kyoung Kim
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kayoung Yi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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137
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Determinants and Two-Year Change in Anterior Chamber Angle Width in a Chinese Population. Ophthalmology 2012; 119:2500-6. [DOI: 10.1016/j.ophtha.2012.06.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/21/2012] [Accepted: 06/28/2012] [Indexed: 11/18/2022] Open
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Craven ER, Katz LJ, Wells JM, Giamporcaro JE. Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up. J Cataract Refract Surg 2012; 38:1339-45. [PMID: 22814041 DOI: 10.1016/j.jcrs.2012.03.025] [Citation(s) in RCA: 247] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 02/11/2012] [Accepted: 03/13/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the long-term safety and efficacy of a single trabecular micro-bypass stent with concomitant cataract surgery versus cataract surgery alone for mild to moderate open-angle glaucoma. SETTING Twenty-nine investigational sites, United States. DESIGN Prospective randomized controlled multicenter clinical trial. METHODS Eyes with mild to moderate glaucoma with an unmedicated intraocular pressure (IOP) of 22 mm Hg or higher and 36 mm Hg or lower were randomly assigned to have cataract surgery with iStent trabecular micro-bypass stent implantation (stent group) or cataract surgery alone (control group). Patients were followed for 24 months postoperatively. RESULTS The incidence of adverse events was low in both groups through 24 months of follow-up. At 24 months, the proportion of patients with an IOP of 21 mm Hg or lower without ocular hypotensive medications was significantly higher in the stent group than in the control group (P=.036). Overall, the mean IOP was stable between 12 months and 24 months (17.0 mm Hg ± 2.8 [SD] and 17.1 ± 2.9 mm Hg, respectively) in the stent group but increased (17.0 ± 3.1 mm Hg to 17.8 ± 3.3 mm Hg, respectively) in the control group. Ocular hypotensive medication was statistically significantly lower in the stent group at 12 months; it was also lower at 24 months, although the difference was no longer statistically significant. CONCLUSIONS Patients with combined single trabecular micro-bypass stent and cataract surgery had significantly better IOP control on no medication through 24 months than patients having cataract surgery alone. Both groups had a similar favorable long-term safety profile. FINANCIAL DISCLOSURE Dr. Craven was an investigator in the clinical trial of the iStent. Dr. Katz is a consultant to Glaukos and was the medical monitor for the clinical trial of the iStent. Dr. Katz is a stockholder in Glaukos. Mr. Wells and Ms. Giamporcaro are employees of Glaukos.
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139
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Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology 2012; 119:1826-31. [PMID: 22608478 DOI: 10.1016/j.ophtha.2012.02.050] [Citation(s) in RCA: 208] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/02/2012] [Accepted: 02/28/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the change in intraocular pressure (IOP) after cataract extraction in the observation group of the Ocular Hypertension Treatment Study. DESIGN Comparative case series. PARTICIPANTS Forty-two participants (63 eyes) who underwent cataract surgery in at least 1 eye during the study and a control group of 743 participants (743 eyes) who did not undergo cataract surgery. METHODS We defined the "split date" as the study visit date at which cataract surgery was reported in the cataract surgery group and a corresponding date in the control group. Preoperative IOP was defined as the mean IOP of up to 3 visits before the split date. Postoperative IOP was the mean IOP of up to 3 visits including the split date (0, 6, and 12 months' with "0 months" equaling the split date). In both groups, we censored data after initiation of ocular hypotensive medication or glaucoma surgery of any kind. MAIN OUTCOME MEASURES Difference in preoperative and postoperative IOP. RESULTS In the cataract group, postoperative IOP was significantly lower than the preoperative IOP (19.8 ± 3.2 mmHg vs. 23.9 ± 3.2 mmHg; P<0.001). The postoperative IOP remained lower than the preoperative IOP for at least 36 months. The average decrease in postoperative IOP from preoperative IOP was 16.5%, and 39.7% of eyes had postoperative IOP ≥ 20% below preoperative IOP. A greater reduction in postoperative IOP occurred in the eyes with the highest preoperative IOP. In the control group, the corresponding mean IOPs were 23.8 ± 3.6 before the split date and 23.4 ± 3.9 after the split date. CONCLUSIONS Cataract surgery decreases IOP in patients with ocular hypertension over a long period of time.
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140
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Long-term effect of phacoemulsification on intraocular pressure using phakic fellow eye as control. J Cataract Refract Surg 2012; 38:866-70. [DOI: 10.1016/j.jcrs.2012.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/08/2011] [Accepted: 11/25/2011] [Indexed: 11/18/2022]
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141
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Heinrich MA, Eppig T, Langenbucher A, Walter S, Behrens-Baumann W, Viestenz A. Comparison of Goldmann applanation and dynamic contour tonometry before and after cataract surgery. J Cataract Refract Surg 2012; 38:683-9. [PMID: 22365580 DOI: 10.1016/j.jcrs.2011.11.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Revised: 11/10/2011] [Accepted: 11/10/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To validate changes in intraocular pressure (IOP) after phacoemulsification with intraocular lens (IOL) implantation without pressure-lowering surgery in previously unoperated eyes of normal and glaucoma patients. SETTING University Eye Clinic, Otto-von-Guericke-University, Magdeburg, Germany. DESIGN Cohort study. METHODS The IOP in both eyes of patients was determined by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) 1 to 2 days before and after uneventful unilateral surgery. Central corneal thickness was used to correct raw GAT readings. RESULTS Of the 50 patients having unilateral phacoemulsification, 29 had had cataract extraction in the contralateral eye. The mean baseline IOP was 17.4 ± 4.4 mm Hg (GAT) and 16.6 ± 2.9 mm Hg (DCT). Postoperatively, the GAT IOP decreased to 16.4 ± 6.5 mm Hg and the DCT IOP increased slightly to 17.1 ± 4.1 mm Hg. The mean tonometer difference (ΔIOP = GAT - DCT) amounted to ΔIOP(pre) = +0.75 ± 2.69 mm Hg in phakic eyes and ΔIOP(post) = -0.70 ± 3.76 mm Hg in pseudophakic eyes (P=.0011). Consistent results were found in pairs of phakic eyes and pseudophakic eyes (mean IOP 18.0 ± 4.8 mm Hg [GAT] and 17.0 ± 3.3 mm Hg [DCT]). In fellow eyes, the mean GAT reading was 13.4 ± 4.4 mm Hg and the mean DCT value, 14.8 ± 2.4 mm Hg. ΔIOP(phakic) was +1.04 ± 2.75 mm Hg and ΔIOP(pseudophakic) was -1.48 ± 2.78 mm Hg (P=.00000021). CONCLUSIONS The GAT IOP readings in pseudophakic eyes seemed to be falsely low. Hence, special attention in the screening, diagnosis, and management of glaucoma is necessary.
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Affiliation(s)
- Mitja A Heinrich
- Department of Ophthalmology, Otto-von-Guericke-University Magdeburg, Germany
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142
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Preoperative iris configuration and intraocular pressure after cataract surgery. J Cataract Refract Surg 2012; 38:117-23. [DOI: 10.1016/j.jcrs.2011.07.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 11/22/2022]
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143
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Lindfield D, Ritchie RW, Griffiths MFP. 'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma. BMJ Open 2012; 2:bmjopen-2011-000578. [PMID: 22649172 PMCID: PMC3367146 DOI: 10.1136/bmjopen-2011-000578] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Does phaco-ECP reduce intraocular pressure? Is phaco-ECP safe? DESIGN Retrospective case note review of all patients undergoing phaco-ECP between June 2008 and June 2009. All glaucoma subtypes were included. SETTING Single District General Hospital Ophthalmology Department within the UK. PARTICIPANTS 58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8). INTERVENTIONS All patients received combined cataract surgery and endoscopic cyclophotocoagulation. OUTCOME MEASURES Follow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed. RESULTS Of the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout. CONCLUSIONS This study confirms the safety of phaco-ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco-ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.
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Affiliation(s)
- Dan Lindfield
- Department of Ophthalmology, Frimley Park Hospital, Camberley, UK
| | - Robert W Ritchie
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
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Walland MJ, Parikh RS, Thomas R. There is insufficient evidence to recommend lens extraction as a treatment for primary open-angle glaucoma: an evidence-based perspective. Clin Exp Ophthalmol 2011; 40:400-7. [PMID: 21668783 DOI: 10.1111/j.1442-9071.2011.02617.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cataract extraction in primary open-angle glaucoma has not been thought to provide a clinically useful or predictable decrease in IOP. This concept has now been challenged, with the opposite belief being promulgated: namely, that lens exchange should be considered as treatment for glaucoma. This revelation could bring a significant change in the glaucoma treatment paradigm. There are no randomised controlled trials to guide the role of lens extraction in primary open-angle glaucoma. The available evidence suggests at most a modest reduction in IOP from cataract extraction - greater in the presence of pseudoexfoliation - which is likely to be of marginal benefit, and only in milder forms of open-angle glaucoma. There is currently no evidence of any quality to suggest that lens extraction routinely represents a clinically useful treatment for primary open-angle glaucoma.
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Affiliation(s)
- Mark J Walland
- Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
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145
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Huang G, Gonzalez E, Lee R, Chen YC, He M, Lin SC. Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract. J Cataract Refract Surg 2011; 38:108-16. [PMID: 22055073 DOI: 10.1016/j.jcrs.2011.06.037] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification. SETTING University of California, San Francisco, California, USA. DESIGN Case series. METHODS Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular-iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular-iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV). RESULTS The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P<.001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P=.041) and preoperative LV (r = 0.235, P=.045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P=.044) and I-Curv (β = 0.235, P=.043) and negatively correlated with preoperative TISA500 (β = -0.269, P=.025) and ACA (β = -0.919, P=.027). CONCLUSIONS Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification.
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Affiliation(s)
- Guofu Huang
- Department of Ophthalmology, University of California, San Francisco, California 94133-0730, USA
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146
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Shin HC, Subrayan V, Tajunisah I. Changes in anterior chamber depth and intraocular pressure after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg 2010; 36:1289-95. [DOI: 10.1016/j.jcrs.2010.02.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/08/2010] [Accepted: 02/15/2010] [Indexed: 11/30/2022]
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