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Sarkar D, Anshukita A, Karkhur S, Sharma B, Gupta S. Anterior Chamber Biometric Parameters Associated With Intraocular Pressure Reduction After Phacoemulsification in Non-Glaucomatous Eyes With Open Angles. Cureus 2024; 16:e51500. [PMID: 38304690 PMCID: PMC10831583 DOI: 10.7759/cureus.51500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Decreased intra-ocular pressure after cataract surgery has been reported in eyes with and without glaucoma with variable magnitude. It is influenced by the anatomical structure of the anterior chamber. Preoperative evaluation of anterior chamber parameters can help to predict the change in intra-ocular pressure postoperatively. OBJECTIVE The objective of the study is to evaluate intraocular pressure (IOP) change after uneventful phacoemulsification in non-glaucomatous eyes with open angles and its correlation with preoperative anterior chamber parameters measured by anterior segment optical coherence tomography (AS-OCT). METHODS In this hospital-based prospective observational study, we included consecutive patients without glaucoma and open angles on gonioscopy who had undergone uncomplicated phacoemulsification with intraocular lens implantation (IOL). IOP and anterior chamber biometric parameters were measured preoperatively and compared with parameters obtained three months post-operatively by AS-OCT. The change in IOP and its relation to the parameters, including anterior chamber angle (ACA), anterior chamber depth (ACD), angle opening distance 500 μm anterior to the scleral spur (AOD500), anterior chamber width (ACW), lens vault (LV), and trabecular iris space area (TISA500) were evaluated. The main outcome measure was a change in IOP after phacoemulsification in normal eyes. RESULTS Sixty-four eyes of 64 patients were enrolled. The mean patient age was 58.5 ± 9.4 years. The average IOP reduction was 2.43±1.64 mm of Hg from a preoperative mean of 16.77±2.54 mmHg three months after phacoemulsification surgery. The mean AOD500 increased significantly (0.440 ± 0.07 to 0.522 ±0.092) from preoperatively to three months postoperatively (p < 0.001). Preoperative lens vault and preoperative IOP had a strong positive correlation with the change in IOP at three months (r-value = 0.606; p-value <0.001) and (r-value = 0.73; p-value <0.001). There was a significant negative correlation between pre-operative TISA and AOD with change in IOP at three months (r-value = -0.545; p-value <0.001) and (r-value = -0.69; p-value <0.01). CONCLUSION Phacoemulsification surgery results in IOP reduction in non-glaucomatous eyes. Pre-operative IOP, lens vault, AOD, and TISA were significant predictors for IOP reduction.
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Affiliation(s)
- Deepayan Sarkar
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
| | | | - Samendra Karkhur
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
| | - Bhavana Sharma
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
| | - Saroj Gupta
- Ophthalmology, All India Institute of Medical Sciences, Bhopal, IND
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Mitchell WG, Azuara-Blanco A, Foster PJ, Halawa O, Burr J, Ramsay CR, Cooper D, Cochran C, Norrie J, Friedman D, Chang D. Predictors of long-term intraocular pressure control after lens extraction in primary angle closure glaucoma: results from the EAGLE trial. Br J Ophthalmol 2023; 107:1072-1078. [PMID: 35387778 DOI: 10.1136/bjophthalmol-2021-319765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 03/18/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To assess baseline ocular parameters in the prediction of long-term intraocular pressure (IOP) control after clear lens extraction (CLE) or laser peripheral iridotomy (LPI) in patients with primary angle closure (PAC) disease using data from the Effectiveness of Early Lens Extraction for the treatment of primary angle-closure glaucoma (EAGLE) tria. METHODS This study is a secondary analysis of EAGLE data where we define the primary outcome of 'good responders' as those with IOP<21 mm Hg without requiring additional surgery and 'optimal responders' as those who in addition were medication free, at 36-month follow-up. Primary analysis was conducted using a multivariate logistic regression model to assess how randomised interventions and ocular parameters predict treatment response. RESULTS A total of 369 patients (182 in CLE arm and 187 in LPI arm) completed the 36-month follow-up examination. After CLE, 90% met our predefined 'good response' criterion compared with 67% in the LPI arm, and 66% met 'optimal response' criterion compared with 18% in the LPI arm, with significantly longer drops/surgery-free survival time (p<0.05 for all). Patients randomised to CLE (OR=10.1 (6.1 to 16.8)), Chinese (OR=2.3 (1.3 to 3.9)), and those who had not previously used glaucoma drops (OR=2.8 (1.6 to 4.8)) were more likely to maintain long-term optimal IOP response over 36 months. CONCLUSION Patients with primary angle closure glaucoma/PAC are 10 times more likely to maintain drop-free good IOP control with initial CLE surgery than LPI. Non-Chinese ethnicity, higher baseline IOP and using glaucoma drops prior to randomisation are predictors of worse long-term IOP response.
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Affiliation(s)
- William G Mitchell
- Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Augusto Azuara-Blanco
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
- Queen's University Belfast, Centre for Public Health, Belfast, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, Institute of Ophthalmology, University College London, London, UK
| | - Omar Halawa
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Jennifer Burr
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
| | - Craig R Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen College of Life Sciences and Medicine, Aberdeen, UK
| | - Claire Cochran
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - David Friedman
- Ophthalmology, Harvard University, Cambridge, Massachusetts, USA
| | - Dolly Chang
- Early Clinical Development, Genentech Inc, South San Francisco, California, USA
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Giglio R, Inferrera L, De Giacinto C, DʼAloisio R, Beccastrini A, Vinciguerra AL, Perrotta AA, Toro MD, Zweifel S, Tognetto D. Changes in Anterior Segment Morphology and Intraocular Pressure after Cataract Surgery in Non-glaucomatous Eyes. Klin Monbl Augenheilkd 2023; 240:449-455. [PMID: 37164442 DOI: 10.1055/a-2013-2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND It is known that cataract extraction is associated with a significant reduction in intraocular pressure, especially in narrow angled eyes; however, the modifications of anterior segment parameters associated with this phenomenon have still not been completely defined. The purpose of this study was to evaluate changes in anterior segment anatomy and intraocular pressure after cataract surgery in non-glaucomatous eyes. METHODS AND MATERIAL This retrospective case series study included 64 eyes of 64 consecutive patients who underwent phacoemulsification with intraocular lens implantation. Anterior segment parameters and intraocular pressure were assessed and compared before and 6 months after surgery. Anterior segment imaging was performed using Casia SS-1000 anterior segment optical coherence tomography (Tomey, Nagoya, Japan). Anterior segment measurements included anterior chamber depth, anterior chamber width, anterior chamber volume, angle opening distance at 500 µm anterior to the scleral spur, angle recess area 750 µm from the scleral spur, lens vault, trabecular iris space area at 500 µm from the scleral spur, and trabecular iris angle at 500 µm from the scleral spur. Intraocular pressure was measured using the Goldmann applanation tonometer (Model AT 900 C/M, Haag-Streit, Bern, Switzerland). Anterior segment parameters and the relationship of changes in intraocular pressure were also evaluated. RESULTS All anterior segment parameters increased significantly after surgery (p < 0.05). Both angle opening distance at 500 µm anterior to the scleral spur and anterior chamber depth changes were positively correlated with the preoperative lens vault. The mean intraocular pressure significantly decreased from 14.91 mmHg (± 2.8 SD) to 12.91 mmHg (± 3.13 SD) (p < 0.001). Changes in intraocular pressure correlated negatively with values for the width of the preoperative anterior chamber (r = - 0.533; p = 0.001). CONCLUSION Cataract surgery led to significant widening of the anterior chamber angle and lowering of intraocular pressure. Further investigations are needed to better understand whether anterior chamber width may be a new independent predictive factor for reduction in postoperative intraocular pressure.
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Affiliation(s)
- Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Leandro Inferrera
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Chiara De Giacinto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Rossella DʼAloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University "G. D'Annunzio" of Chieti Pescara, Chieti, Italy
| | - Andrea Beccastrini
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Lucia Vinciguerra
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Armando Perrotta
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Mario Damiano Toro
- Eye Clinic, Department of Public Health, University of Naples Federico II, Napoli, Italy
- Chair and Department of General and Paediatric Ophthalmology, Medical University of Lublin, Lublin, Poland
| | - Sandrine Zweifel
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Changes in Macular Thickness after Cataract Surgery in Patients with Open Angle Glaucoma. Diagnostics (Basel) 2023; 13:diagnostics13020244. [PMID: 36673054 PMCID: PMC9857709 DOI: 10.3390/diagnostics13020244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine the changes in IOP, total macular and RNFL, ganglion cell layer (GCL) thickness, and aqueous humour flare in open angle glaucoma (OAG) patients before and 6 months after cataract surgery. METHODS This was a prospective observational case-control age- and gender-matched study. Groups: 40 subjects in a controlled OAG (OAGc) group, 20 subjects in an uncontrolled OAG (OAGu) group, and 60 control group subjects. EXAMINATION complete ophthalmic evaluation, IOP measurement, anterior and posterior segment Optical Coherence Tomography (OCT), and laser flare photometry before and 6 months postoperatively. RESULTS Six months postoperatively IOP decreased in all groups. An increase in macular thickness was found postoperatively in all groups. Preoperative aqueous humour flare was higher in the OAGc group than in the control group. After cataract surgery, aqueous humour flare was higher in the control group compared to the preoperative result. CONCLUSIONS Changes in IOP following cataract surgery were strongly negatively correlated with preoperative IOP. An increase in macular thickness was observed 6 months postoperatively in all groups. Aqueous humour flare did not differ in OAGc and OAGu groups pre- and postoperatively but significantly increased in the control group postoperatively.
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Predictors of intraocular pressure change after cataract surgery in patients with pseudoexfoliation glaucoma and in nonglaucomatous patients. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200421081m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The cataract surgery in eyes with and without glaucoma results in the sustained intraocular pressure (IOP) reduction but it is still unknown which glaucomatous patients will achieve clinically significant reduction. The preoperative IOP and some ocular biometric parameters have been shown as potential predictors of the postoperative IOP reduction. The aim of our prospective intervention study was to evaluate that relationship in medically controlled patients with the pseudoexfoliation glaucoma (PXG) and in the nonglaucomatous patients. Methods. Thirty-one PXG patients (31 eyes) and 31 nonglaucomatous patients (31 eyes), all with clinically significant cataract, were enrolled. The preoperative IOP, anterior chamber depth (ACD), axial length (AL), lens thickness (LT), lens position (LP) [LP = ACD + 0.5 LT], relative lens position (RLP) [RLP = LP / AL] and the pressure-to-depth ratio (PD ratio) [PD ratio = preoperative IOP/preoperative ACD] were evaluated as potential predictors of the IOP change in the 6th postoperative month. Results. In the 6th postoperative month, in the PXG group, the IOP reduction was -3.23 ? 3.41 mmHg (-17.67 ? 16.86%) from the preoperative value of 16.27 ? 3.08 mmHg and in the control group, the reduction was -2.26 ? 1.71 mmHg (-15.06 ? 10.93%) from the preoperative value of 14.53 ? 2.04 mmHg. In the PXG group, the significant predictors of the absolute and the percentage IOP reduction were the preoperative IOP, AL, and PD ratio. In the same group, RLP was shown as a significant predictor of absolute change in the IOP in multi-variate analysis, and the percentage IOP change in both the univariate and the multivariate analyses. In the control group, the preoperative IOP and the PD ratio were the only significant parameters that could predict absolute change in the postoperative IOP. Conclusion. The cataract surgery leads to the IOP reduction both in the PXG and nonglaucomatous eye. Predictors monitored in this study are widely available and simply calculable parameters that can be potentially used in managing glaucoma.
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Allam RS, Raafat KA, Elmohsen MNA. Nasal trabeculo-ciliary angle and relative lens vault as predictors for intraocular pressure reduction following phacoemulsification. Eur J Ophthalmol 2021; 32:3019-3028. [PMID: 34751051 DOI: 10.1177/11206721211055033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate quantitative relationships between biometric measurements and expected intraocular pressure reduction following phacoemulsification. DESIGN A prospective, comparative clinical study. METHODS Forty nine candidates for phacoemulsification were included. Intraocular pressure was measured preoperatively and after 7 and 30 days. Ocular biometrics were measured using optical biometry and ultrasound biomicroscopy preoperatively and 1 month postoperatively. RESULTS Patients were sub-grouped into open-angle glaucoma (12 eyes), angle-closure glaucoma (18 eyes), and cataract-only groups (19 eyes). The mean intraocular pressure reduction was -1.67 ± 2.73, -13.11 ± 7.98, and -7.50 ± 3.58 mmHg in the cataract-only, angle-closure glaucoma, and open-angle glaucoma groups (p = 0.001). The delta-intraocular pressure at day 7 showed positive correlations with lens vault and relative-lens vault (p = 0.005 and 0.001). It showed negative correlations with lens position, relative-lens position, anterior chamber depth, aqueous depth, and nasal and temporal angles in addition to lens thickness, anterior vault, nasal trabeculo-ciliary angle, and temporal-trabeculo-ciliary angle at the end of the follow-up period. Regression analysis revealed significant associations between preoperative intraocular pressure and both nasal-trabeculo-ciliary angle and anterior vault (p = 0.038 and 0.019) and delta-intraocular pressure and both nasal-trabeculo-ciliary angle and relative-lens vault (p = 0.001 and ≤0.001) with an area under the curve of 0.71 for relative-lens vault. For every degree decrease in nasal-trabeculo-ciliary angle, there was an expected 0.33 mmHg intraocular pressure reduction with no expected change if nasal-trabeculo-ciliary angle decreased to <22°. CONCLUSIONS The relationship between anterior-segment-biometrics could determine intraocular pressure behavior after phacoemulsification. The preoperative nasal-trabeculo-ciliary angle and relative-lens vault could be significant predictors for postoperative intraocular pressure reduction.
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Affiliation(s)
- Riham Shm Allam
- Department of Ophthalmology, Faculty of Medicine, Kasr Al Ainy School of Medicine, 63527Cairo University, Egypt
| | - Karim A Raafat
- Department of Ophthalmology, Faculty of Medicine, Kasr Al Ainy School of Medicine, 63527Cairo University, Egypt
| | - Mai Nasser Abd Elmohsen
- Department of Ophthalmology, Faculty of Medicine, Kasr Al Ainy School of Medicine, 63527Cairo University, Egypt
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Zheng Q, Hu M, Li ZL, Chang PJ, Zhao YE. Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT. Int J Ophthalmol 2021; 14:1527-1532. [PMID: 34667728 DOI: 10.18240/ijo.2021.10.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.
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Affiliation(s)
- Qian Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Man Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Zhang-Liang Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Ping-Jun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yun-E Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
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Bayat AH, Akpolat C. The change of anterior chamber angle parameters after cataract surgery in diabetic patients. Ther Adv Ophthalmol 2021; 13:25158414211034717. [PMID: 34409258 PMCID: PMC8365015 DOI: 10.1177/25158414211034717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose of this study is to investigate the change of anterior chamber angle morphology after cataract surgery in patients with type 2 diabetes mellitus (DM2) using anterior segment optical coherence tomography (AS-OCT). Methods: In this prospective and comparative study, 57 eyes of the patients with cataract were investigated. The patients were divided into two groups. The DM2 group included cataractous type 2 diabetic patients without diabetic retinopathy (n = 30) and the non-DM2 group included nondiabetic participants with cataract (n = 27). The AS-OCT examinations were performed at baseline and 1 month after the cataract surgery. The corrected distance visual acuity (CDVA), intraocular pressure (IOP), angle-opening distance at 500 µm (AOD-500) and trabecular iris space area at 500 µm (TISA-500), and scleral spur angle (SSA) in temporal quadrant were analyzed. Results: The mean age, sex, and axial length values were similar in both groups (p > 0.05 for all). The CDVA was significantly improved in both groups (p < 0.001). The mean AOD-500, TISA-500, and SSA were increased and the mean IOP was decreased after cataract surgery in both groups (p < 0.001 for all). There were not any statistically significant intergroup differences in CDVA, IOP, and AS-OCT measurements between the DM2 and non-DM2 groups (p > 0.05 for all). Conclusion: Cataract surgery showed significant increases in mean anterior chamber angle parameters and reductions in IOP values in both diabetic and nondiabetic patients without intergroup significant differences. These results suggested the safety and effectiveness of cataract surgery, especially regarding anterior chamber angle parameters and so IOP changes.
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Affiliation(s)
- Alper Halil Bayat
- Department of Ophthalmology, Esenler Hospital, Medipol University, Birlik Mah Bahçeler cad. no:5 Esenler 34320, Istanbul, Turkey
| | - Cetin Akpolat
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Changes in ocular morphology after cataract surgery in open angle glaucoma patients. Sci Rep 2021; 11:12203. [PMID: 34108591 PMCID: PMC8190274 DOI: 10.1038/s41598-021-91740-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/28/2021] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study was to evaluate intraocular pressure (IOP) pre- and postoperatively, together with anterior chamber angle (ACA) parameters and biometrical results in cataract patients with or without open angle glaucoma (OAG). The prospective observational case-control study included 15 eyes with cataract and OAG in the glaucoma group and 25 eyes with only cataract in control group. Examination included full ophthalmic evaluation, IOP, ocular biometry and anterior segment optical coherence tomography measuring ACA pre- and 6 months postoperatively. OAG patients had a larger absolute IOP reduction compared to control group. Anterior chamber depth (ACD) and ACA width significantly increased in both groups. The OAG group had a tendency of narrower ACA preoperatively, but overall ACA parameters did not differ in either group pre- and postoperatively. The ACD change after surgery correlated with ACA parameters in the control group, but not in OAG group. Axial length was shorter postoperatively in the control group, but remained similar in the OAG group. Absolute IOP reduction was more pronounced in cataract patients with OAG than in cataract patients without glaucoma. ACD and ACA postoperatively increased in both groups and AL shortening was observed in non-OAG in cataract group.
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Ramezani F, Nazarian M, Rezaei L. Intraocular pressure changes after phacoemulsification in pseudoexfoliation versus healthy eyes. BMC Ophthalmol 2021; 21:198. [PMID: 33957872 PMCID: PMC8101166 DOI: 10.1186/s12886-021-01970-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pseudoexfoliation (PXF) syndrome is the most common cause of secondary glaucoma worldwide. This systemic disorder causes further damage to the optic nerve and ultimately increases the need for surgical interventions. Therefore, intraocular pressure (IOP) control is very important in these patients. The aim of this study was to compare IOP changes after phacoemulsification in subjects with PXF syndrome compared to those without this syndrome. Methods 61 patients were enrolled in this prospective clinical study. Subjects were assigned into two groups based on presence or absence of PXF syndrome. IOP and anterior chamber angle parameters including: angle opening distance (AOD) and trabecular-iris surface area (TISA) measured one day preoperatively and 3 months postoperatively. Intraoperative metrics factors including: infusion fluid usage (IFU), cumulative dissipated energy (CDE) and aspiration time (AT) were obtained from the phacoemulsification machine at the end of each surgery. IOP changes, anterior chamber angle parameters and intraoperative metrics factors were compared between groups. Results Mean IOP before surgery was significantly higher in the PXF group (14.70 mm Hg) compared to controls (12.87 mm Hg) (P-value < 0.01). Phacoemulsification decreased IOP in both, but to greater extent in the PXF group (p-value < 0.01). AOD and TISA also increased significantly following surgery in both groups. The results showed that postoperative IOP was negatively correlated with preoperative IOP in both groups (p-value < 0.01). Also, IOP after phacoemulsification was negatively correlated with IFU in the PXF group (p-value = 0.03). Conclusions Patients with PXF syndrome exhibited a reduction in IOP and increase in anterior chamber angle parameters after phacoemulsification. We observed a greater IOP reduction in PXF subjects when it was compared to controls. Higher preoperative IOP and intraoperative IFU were associated with more IOP reduction in the PXF group.
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Affiliation(s)
- Farshid Ramezani
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Nazarian
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Rezaei
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Intraocular Pressure and Anterior Segment Morphometry Changes after Uneventful Phacoemulsification in Type 2 Diabetic and Nondiabetic Patients. J Ophthalmol 2019; 2019:9390586. [PMID: 31281671 PMCID: PMC6590574 DOI: 10.1155/2019/9390586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 05/23/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare intraocular pressure (IOP) and anterior segment (AS) morphometry changes after uneventful phacoemulsification between nonglaucomatous eyes with open-angles from patients with and without type 2 diabetes mellitus (DM) and determine which factors may predict greater IOP-lowering effect. Methods Forty-five diabetic (45 eyes) and 44 (44 eyes) age- and sex-matched non-DM patients with age-related cataract were enrolled in this prospective observational study. Goldmann applanation tonometry and AS Scheimpflug tomography (Pentacam® HR) were performed preoperatively and at 1- and 6-month follow-up. Linear regression analysis was performed to evaluate the clinical variables related to postoperative IOP changes at 6 months. Results There was a significant postoperative IOP reduction 6 months after surgery (p < 0.001) by an average of 2.9 ± 2.9 mmHg (15.5%) and 2.4 ± 2.8 mmHg (13.0%) in the DM group and non-DM groups (p = 0.410), respectively. All AS parameters (anterior chamber depth, volume, and angle) increased significantly postoperatively (p < 0.001). Multivariate linear regression analysis showed that higher preoperative IOP was significantly associated with IOP reduction at 6-month follow-up (p < 0.05). Conclusion Nonglaucomatous eyes with open-angles from both type 2 diabetic and nondiabetic patients experienced similar AS changes and IOP reductions following uneventful phacoemulsification, and this IOP-lowering effect was strongly correlated with preoperative IOP.
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Wang Q, Perez CI, Masis M, Feinstein M, Mora M, Lin SC, Hsia YC. Post-phacoemulsification iris changes in eyes with glaucoma or glaucoma suspect status. PLoS One 2018; 13:e0208776. [PMID: 30543659 PMCID: PMC6292659 DOI: 10.1371/journal.pone.0208776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose This prospective study used anterior segment optical coherence tomography (AS-OCT) to determine how phacoemulsification (phaco) changes iris parameters in eyes with glaucoma or glaucoma suspect status. Methods Using Visante AS-OCT (Carl Zeiss Meditec AG), the following pre- and post-phaco parameters were measured: IT750 = iris thickness at 750 μm from the scleral spur; IT2000 = iris thickness 2000 μm from the scleral spur; ITCM = the maximum iris thickness at the middle one third of the iris; ICURV = iris curvature; IAREA = iris area; and pupil size = pupil diameter (mm). Only high-quality images with an identifiable scleral spur were included, and only the nasal quadrant was analyzed. A single glaucoma specialist analyzed the parameters according to the Zhongshan Angle Assessment Program (ZAAP, Guangzhou, China). Multivariate analysis was performed using mixed effects regression correcting for age, gender, and ethnicity. Results 89 subjects and 110 eyes were included in this study. The mean age of subjects was 74.83 {+/-} 8.69 years old. Most common diagnoses were POAG and glaucoma suspect (23% and 52%, respectively), and 16% of subjects had an LPI. In multivariate analysis of AS-OCT parameters, decreases in IT750, IT2000, ITCM, ICURV, and pupil size were statistically significant (p<0.05). Conclusions After phacoemulsification, eyes with glaucoma as well as glaucoma suspect eyes have thinner irises and smaller pupils. This may lead to less iris-mediated aqueous outflow obstruction, providing support for early phacoemulsification glaucoma treatment. Translational relevance Our AS-OCT imaging findings may guide clinical practice as iris parameters become increasingly relevant in preoperative phaco planning.
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Affiliation(s)
- Qinyun Wang
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
- * E-mail:
| | - Claudio I. Perez
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
- Fundación Oftalmológica los Andes, Universidad los Andes, Santiago, Chile
| | - Marissé Masis
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
| | - Max Feinstein
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
| | - Marta Mora
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
| | - Shan C. Lin
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
| | - Yen C. Hsia
- University of California at San Francisco, Department of Ophthalmology, San Francisco, California, United States of America
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Yoo C, Amoozgar B, Yang KS, Park JH, Lin SC. Glaucoma severity and intraocular pressure reduction after cataract surgery in eyes with medically controlled glaucoma. Medicine (Baltimore) 2018; 97:e12881. [PMID: 30335009 PMCID: PMC6212290 DOI: 10.1097/md.0000000000012881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the relationship between glaucoma severity and intraocular pressure (IOP) reduction after cataract surgery in patients with medically controlled primary open-angle glaucoma (POAG).Retrospective case series.This study included glaucoma suspects (GS) and POAG patients who underwent cataract surgery and continued to use the same glaucoma medications during the postoperative period of 4 months. The main outcomes were percent and absolute IOP changes calculated using the preoperative IOP and the postoperative IOP at 3 months. Preoperative glaucoma medications, preoperative IOP, demographic information, biometric parameters and variables for glaucoma severity were evaluated as potential predictors of IOP change.The average IOP reduction was 3.3 ± 2.4 mmHg (20.0%) and 2.2 ± 2.5 mmHg (13.1%) from the preoperative mean of 16.0 ± 2.9 mmHg and 15.2 ± 3.3 mmHg in the GS and POAG groups, respectively. Preoperative IOP, preoperative IOP/anterior chamber depth (preoperative IOP/ACD [PD ratio]) and preoperative IOP/retinal nerve fiber layer (RNFL) thickness (preoperative IOP/RNFL [PNFL ratio]) and preoperative IOP score x MD score x number of glaucoma medications (glaucoma index) predicted absolute IOP change in the POAG group, whereas preoperative IOP, PD ratio, PNFL ratio, and axial length (AL) did in the GS group. Preoperative IOP, PD ratio, and PNFL ratio predicted %IOP change in the POAG group, whereas only AL did in the GS group.In medically controlled POAG eyes, structural or functional parameters for glaucoma severity did not independently predict IOP change following phacoemulsification. However, novel severity indices obtained by addition of preoperative IOP and/or glaucoma medications to the structural or functional parameter predicted IOP changes.
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Affiliation(s)
- Chungkwon Yoo
- Department of Ophthalmology, University of California, San Francisco, CA
- Department of Ophthalmology
| | - Behzad Amoozgar
- Department of Ophthalmology, University of California, San Francisco, CA
| | - Kyung-Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | | | - Shan C. Lin
- Department of Ophthalmology, University of California, San Francisco, CA
- Glaucoma Center of San Francisco, San Francisco, CA
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Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract. J Glaucoma 2018; 27:711-716. [DOI: 10.1097/ijg.0000000000000998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Implantable Collamer Lens Sizing Method Based on Swept-Source Anterior Segment Optical Coherence Tomography. Am J Ophthalmol 2018; 187:99-107. [PMID: 29294311 DOI: 10.1016/j.ajo.2017.12.015] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE To develop and evaluate the accuracy of a size-determination formula using anterior segment optical coherence tomography (AS-OCT) parameters. DESIGN Interventional case series. METHODS This study included 46 eyes of 23 patients with implantable collamer lens (ICL). Preoperatively, the anterior segment parameters were measured using high-frequency ultrasound biomicroscopy and AS-OCT. Three months postoperatively, the vaults were measured and the optimal ICL size was calculated using a previously published method. Stepwise multiple regression analysis was performed using the optimal ICL size as a dependent variable; the NK-formula was obtained. Thereafter, 35 eyes of 18 patients were implanted with ICL after the size was calculated using the NK-formula. Vaults measured at 3 months postoperatively were used to evaluate the accuracy of the NK-formula. RESULTS The distance between scleral spurs (ACW) and crystalline lens rise (CLR) were selected as significant parameters for the regression model (R2 = 0.68, P < .05). There were 25 (71%), 8 (23%), and 2 (6%) eyes in the moderate, high, and low vault categories, respectively. Using the STAAR nomogram for ICL sizing, 24 eyes (69%) were fitted in the moderate vault. The mean absolute error of the predicted vault was significantly lower with the NK-formula (0.190 ± 0.129 mm) than with the STAAR nomogram (0.331 ± 0.235 mm, P = .002, paired t test). CONCLUSION AS-OCT is useful for ICL size determination, because it calculates the anterior segment parameters using automatic analysis. The NK-formula shows higher accuracy for predicting vault than the STAAR nomogram.
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Masis Solano M, Lin SC. Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle? Prog Retin Eye Res 2018; 64:77-83. [PMID: 29374584 DOI: 10.1016/j.preteyeres.2018.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Abstract
Cataract extraction is a safe and effective surgery that has a lowering effect on the intraocular pressure. The specific mechanisms for this effect are still unclear. A direct inflammatory effect on the trabecular meshwork, alteration of the blood aqueous barrier, changes in the ciliary body and mechanical changes of the anterior segment anatomy are the key to understand cataract surgery and it's effects on aqueous humor dynamics. Additionally, with the advent of AS OCT, changes in the anterior segment of the eye have been studied and several parameters (such as lens vault, angle opening distance and anterior chamber depth) have been identified as predictors of intraocular pressure change. In eyes with narrow angles there is a greater drop in intraocular pressure after cataract surgery and it is correlated with parameters related to anterior chamber space. It is safe to affirm that cataract surgery is an important part of the modern glaucoma treatment and evidence should be analyzed as part of a bigger picture in order to more accurately understand its clinical relevance.
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Affiliation(s)
- Marisse Masis Solano
- Koret Vision Center, Department of Ophthalmology, University of California, San Francisco Medical School, 10 Koret Way, San Francisco, CA 94143, United States
| | - Shan C Lin
- Koret Vision Center, Department of Ophthalmology, University of California, San Francisco Medical School, 10 Koret Way, San Francisco, CA 94143, United States.
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Lin SC, Masis M, Porco TC, Pasquale LR. Predictors of Intraocular Pressure After Phacoemulsification in Primary Open-Angle Glaucoma Eyes with Wide Versus Narrower Angles (An American Ophthalmological Society Thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2017; 115:T6. [PMID: 29147104 PMCID: PMC5665659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess if narrower-angle status and anterior segment optical coherence tomography (AS-OCT) parameters can predict intraocular pressure (IOP) drop in primary open-angle glaucoma (POAG) patients after cataract surgery. METHODS This was a prospective case series of consecutive cataract surgery patients with POAG and no peripheral anterior synechiae (PAS) using a standardized postoperative management protocol. Preoperatively, patients underwent gonioscopy and AS-OCT. The same glaucoma medication regimen was resumed by 1 month. Potential predictors of IOP reduction included narrower-angle status by gonioscopy and angle-opening distance (AOD500) as well as other AS-OCT parameters. Mixed-effects regression adjusted for use of both eyes and other potential confounders. RESULTS We enrolled 66 eyes of 40 glaucoma patients. The IOP reduction at 1 year was 4.2±3 mm Hg (26%, P<.001) in the narrower-angle group vs 2.2±3 mm Hg (14%, P<.001) in the wide-angle group (P=.027 for difference), as classified by gonioscopy. By AOD500 classification, the narrower-angle group had 3.4±3 mm Hg (21%, P<.001) reduction vs 2.5±3 mm Hg (16%, P<.001) in the wide-angle group (P=.031 for difference). When the entire cohort was assessed, iris thickness, iris area, and lens vault were correlated with increasing IOP reduction at 1 year (P<.05 for all). CONCLUSIONS In POAG eyes, cataract surgery lowered IOP to a greater degree in the narrower-angle group than in the wide-angle group, and parameters relating to iris thickness and area, as well as lens vault, were correlated with IOP reduction. These findings can guide ophthalmologists in their selection of cataract surgery as a potential management option.
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Coh P, Moghimi S, Chen RI, Hsu CH, Masís Solano M, Porco T, Lin SC. Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Glaucomatous Versus Nonglaucomatous Eyes. Invest Ophthalmol Vis Sci 2017; 57:2593-9. [PMID: 27163773 PMCID: PMC4868101 DOI: 10.1167/iovs.16-19384] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the relationship between lens position parameters and intraocular pressure (IOP) reduction after cataract surgery in patients with primary open-angle glaucoma (POAG) and in nonglaucomatous patients. Methods The main outcomes of this prospective study were percent and absolute IOP change, which were calculated using the preoperative IOP and the IOP 4 months after cataract surgery in POAG and nonglaucomatous eyes. Lens position (LP), defined as anterior chamber depth (ACD) + one-half lens thickness (LT), was assessed preoperatively using parameters from optical biometry. Preoperative IOP, axial length (AL), ACD, LT, relative lens position (RLP), and the ratio of preoperative IOP to ACD (PD ratio) were also evaluated as potential predictors of IOP change. Results Four months postoperatively, the average IOP reduction was 2.80 ± 3.83 mm Hg (15.79%) from the preoperative mean of 14.73 ± 2.89 mm Hg for nonglaucomatous eyes. The average IOP reduction was 2.66 ± 2.07 mm Hg (16.98%) from the preoperative mean of 14.86 ± 2.97 mm Hg for POAG eyes. Preoperative IOP, sex, AL, ACD, PD ratio, and LP predicted IOP change in nonglaucomatous eyes. Preoperative IOP and PD ratio predicted IOP change in POAG eyes. Conclusions Intraocular pressure reduction after phacoemulsification cataract surgery in nonglaucomatous eyes is significantly greater in more anteriorly positioned lenses. Though it did not reach statistical significance in patients with glaucoma, the association of LP with IOP reduction is in the same direction as in nonglaucomatous patients where smaller LP appears to predict greater IOP reduction. Lens position is a simple, easily calculable, accurate, and widely available parameter, which clinicians can potentially utilize in managing glaucoma.
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Affiliation(s)
- Paul Coh
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States
| | - Sasan Moghimi
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 2Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rebecca I Chen
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 3Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Chi-Hsin Hsu
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 4Department of Ophthalmology, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Marissé Masís Solano
- Department of Ophthalmology University of California-San Francisco, San Francisco, California, United States 5Department of Ophthalmology, Costa Rica University, Clinica Oftalmologica/CCSS, San Jose, Costa Rica
| | - 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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Kim YC, Sung MS, Heo H, Park SW. Anterior segment configuration as a predictive factor for refractive outcome after cataract surgery in patients with glaucoma. BMC Ophthalmol 2016; 16:179. [PMID: 27756264 PMCID: PMC5070221 DOI: 10.1186/s12886-016-0359-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/11/2016] [Indexed: 12/30/2022] Open
Abstract
Background To compare refractive outcomes after cataract surgery between patients with closed-angle and open-angle glaucoma and evaluate the influence of preoperative factors on refractive outcomes in patients with glaucoma. Methods Patients diagnosed with glaucoma and who underwent uncomplicated cataract surgery were enrolled in this retrospective observational study. We collected data including age, history of prior laser peripheral iridotomy and trabeculectomy, type of glaucoma, manifest refraction, intraocular pressure, axial length, and various anterior segment parameters using anterior-segment optical coherence tomography. Factors associated with unsatisfactory refractive outcome at postoperative 6 month were evaluated. Results A total of 143 eyes (143 subjects) were included. Of these, 49 and 94 had closed-angle and open-angle glaucoma, respectively. At postoperative-6 month evaluation, the mean absolute error (MAE) predicted by the SRK-II and SRK-T formulae was 0.67 ± 0.61 and 0.81 ± 0.66 diopters (D), respectively. The overall predictability of achieving within ± 1.0 D of target was 76.92 % and 72.73 %, respectively. At a cutoff value of 1.0 D for MAE, there was no statistical significant difference in refractive outcome between the closed-angle and open-angle glaucoma groups. Logistic regression modeling showed that large lens vault (LV) was a significant predictor of unsatisfactory refractive outcome after cataract surgery in patients with glaucoma. Conclusions When considering cataract surgery in patients with glaucoma, surgeons should recognize that the refractive outcomes may be unsatisfactory in eyes with large LV.
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Affiliation(s)
- Young Cheong Kim
- Department of Medical Science Graduate School, Chonnam National University, Gwangju, Republic of Korea
| | - Mi Sun Sung
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Hwan Heo
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea
| | - Sang Woo Park
- Department of Ophthalmology and Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, Republic of Korea. .,Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, Republic of Korea.
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Moghimi S, Johari M, Mahmoudi A, Chen R, Mazloumi M, He M, Lin SC. Predictors of intraocular pressure change after phacoemulsification in patients with pseudoexfoliation syndrome. Br J Ophthalmol 2016; 101:283-289. [PMID: 27281754 DOI: 10.1136/bjophthalmol-2016-308601] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 05/11/2016] [Indexed: 11/03/2022]
Abstract
AIM To evaluate anterior chamber biometric factors and intraoperative metrics associated with the intraocular pressure (IOP) reduction after phacoemulsification in non-glaucomatous pseudoexfoliative syndrome (PXS) eyes. METHOD Thirty-three patients were enrolled in this prospective interventional study. Images were excluded if they had poor quality, poor perpendicularity or inability to locate sclera spurs. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris area, iris curvature, lens vault, angle opening distance (AOD500, AOD750) and trabecular iris space area (TISA500, TISA750) were measured in qualified images using the Zhongshan Angle Assessment Program and compared preoperatively and 3 months postoperatively. Cumulative dissipated energy (CDE), aspiration time and infusion fluid usage during cataract surgery were obtained from the phacoemulsification machine's metrics record. Postoperative IOP change was compared with these anatomical and intraoperative metric parameters. RESULTS Mean IOP was 18.1±3.4 mm Hg preoperatively and decreased by 3.3 mm Hg (18%) to 14.8±3.6 mm Hg at 3 months postoperatively (p<0.001). All angle parameters, ACD and ACA increased significantly postoperatively (p<0.001 for all) and iris curvature decreased (p<0.001). In univariate analysis, preoperative IOP (B=-0.668, p=0.002), infusion fluid usage (B=-0.040, p=0.04) and aspiration time (B=-0.045, p=0.003) were negatively associated with IOP decrease after phacoemulsification. Changes in IOP did not demonstrate significant associations with CDE measurements or anterior segment optical coherence tomography measurements, including preoperative angle, iris or anterior segment parameters. In the final multivariate regression model, preoperative IOP (B=-0.668, p=0.002) and infusion fluid usage (B=-0.041, p=0.04) were significantly associated with IOP drop and together can predict 45.1% (p=0.002) of the variability in IOP change. CONCLUSIONS Non-glaucomatous patients with PXS experience moderate IOP reduction following phacoemulsification, and this effect is correlated with preoperative IOP, aspiration time and infusion fluid used intraoperatively.
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Affiliation(s)
- Sasan Moghimi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Beckman Vision Center, University of California, San Francisco, California, USA
| | | | - Alireza Mahmoudi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rebecca Chen
- Beckman Vision Center, University of California, San Francisco, California, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mehdi Mazloumi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mingguang He
- Department of Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Shan C Lin
- Beckman Vision Center, University of California, San Francisco, California, USA
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Early phacoemulsification in patients with acute primary angle closure. J Curr Ophthalmol 2016; 27:70-5. [PMID: 27239581 PMCID: PMC4881187 DOI: 10.1016/j.joco.2015.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/28/2015] [Accepted: 12/09/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare long term efficacy of phacoemulsification in the early management of acute primary angle closure (APAC) after aborting an acute attack and performing laser peripheral iridotomy (LPI). METHODS In this nonrandomized comparative prospective study, we included 35 subjects presenting with APAC who had responded to medical treatment and LPI with intraocular pressure (IOP) less than 25 mmHg. Twenty patients with visually significant cataract with visual acuity of <20/30 were assigned to the "Phaco/LPI" group and underwent phacoemulsification within 6 weeks of the attack. Fifteen subjects with clear lens were assigned to the "LPI Only" group and were followed clinically. The primary measured outcome was the prevalence of IOP rise after 1 month (treatment failure), defined as 1) if a patient developed IOP rise resulting in IOP >21 mmHg with or without medication, or 2) if a patient required any medication to have IOP ≤21 mmHg after 1 month. Patients were followed for at least one year. RESULT IOP, number of medications, gonioscopy grading, and amount of synechiae were not significantly different at baseline between the two groups. Acute attack did not recur in any patient. There was more significant failure in the LPI Only group compared with the Phaco/LPI group (40% vs. 5%; p = 0.02). There was a significant difference in final IOP between the two study groups (13.90 ± 2.17 vs. 17.8 ± 4.16 in the Phaco/LPI and LPI Only groups, respectively; p = 0.001). Patients in the Phaco-LPI group needed less medication than the other group at final follow-up. No serious complications have arisen from the immediate LPI or phacoemulsification. CONCLUSION Phacoemulsification is a safe procedure for preventing IOP rise after aborting acute primary angle closure if performed within a few weeks of the attack.
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