1
|
Abstract
PURPOSE OF REVIEW To review the current literature on the relationship between cataract extraction and intraocular pressure (IOP). RECENT FINDINGS Cataract extraction can be an effective IOP lowering treatment for open and closed angle glaucoma as well as ocular hypertension. In comparative trials studying novel micro-invasive glaucoma surgeries in open angle glaucoma, the control group undergoing cataract extraction alone routinely achieved significant reductions in IOP and medication use postoperatively. Data from the Effectiveness in Angle Closure Glaucoma of Lens Extraction (EAGLE) trials have demonstrated that lens extraction is more effective at lowering IOP than peripheral iridotomy in patients with angle closure and should be considered as first line therapy. Additionally, patients in the ocular hypertension treatment study who underwent cataract extraction over the course of follow-up demonstrated significant IOP lowering sustained over 3 years. SUMMARY Cataract extraction is an effective method to lower IOP in patients with glaucoma. Pressure lowering is more significant in eyes with narrow angles and those with higher baseline IOP levels. In eyes with angle closure, phacoemulsification alone can lower IOP, but when combined with GSL it may be even more effective. Recent large multicenter randomized trials have further elucidated the benefit of standalone cataract extraction to treat mild to moderate primary open angle glaucoma. Prospective and longitudinal studies that systematically investigate the variables that may influence degree and duration of IOP lowering post cataract extraction are lacking.
Collapse
|
2
|
Majstruk L, Leray B, Bouillot A, Michée S, Sultan G, Baudouin C, Labbé A. Long term effect of phacoemulsification on intraocular pressure in patients with medically controlled primary open-angle glaucoma. BMC Ophthalmol 2019; 19:149. [PMID: 31300022 PMCID: PMC6626376 DOI: 10.1186/s12886-019-1157-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 07/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background 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 . Methods Seventy 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. Results One 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. Conclusion Cataract 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.
Collapse
Affiliation(s)
- Loic Majstruk
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.
| | - Benjamin Leray
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
| | - Aymeric Bouillot
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
| | - Sylvain Michée
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Gilles Sultan
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Christophe Baudouin
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.,INSERM U968; UPMC Univ Paris 06, UMR_S968, Institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France
| | - Antoine Labbé
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.,Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.,INSERM U968; UPMC Univ Paris 06, UMR_S968, Institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France
| |
Collapse
|