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Vallée R, Meduri E, Vallée JN, Lallouette A, Haffane Z, Paillard A, Mansouri K, Mermoud A. Predictive biomarkers of intra-ocular pressure decrease after cataract surgery associated with trabecular washout in patients with pseudo exfoliative glaucoma. Sci Rep 2024; 14:13567. [PMID: 38866840 PMCID: PMC11169244 DOI: 10.1038/s41598-024-53893-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/06/2024] [Indexed: 06/14/2024] Open
Abstract
To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOPBL) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOPBL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOPBL was 0.85 and 0.94 (p < 0.0001, respectively), with IOPBL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOPBL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease.
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Affiliation(s)
- Rodolphe Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France.
- Mathematics and Applications Laboratory (LMA), CNRS UMR7348, LRCOM i3M-DACTIMMIS, University of Poitiers, Poitiers, France.
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
| | - Enrico Meduri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Jean-Noël Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France
| | - Athena Lallouette
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Zakarya Haffane
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Archibald Paillard
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Ophthalmology Department, Colorado University Medical School, Denver, CO, USA
| | - André Mermoud
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
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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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Devience EX, Awidi A, Kalarn S, DeVience S, Bui B, Munir WM, Kaleem MA, Im L, Jeng BH, Daoud Y, Saeedi OJ. Predictors of intraocular pressure reduction after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a prospective trial. Int Ophthalmol 2023; 43:285-292. [PMID: 35870049 DOI: 10.1007/s10792-022-02427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS). METHODS This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts. RESULTS In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (-2.2 ± 3.4 mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6 months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6 months. CONCLUSION Both FLACS and CPS resulted in similar and significant IOP reductions through 6 months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.
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Affiliation(s)
| | - Abdelhalim Awidi
- Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Sachin Kalarn
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | | | - Brendan Bui
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Wuqaas M Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Mona A Kaleem
- Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Lily Im
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Yassine Daoud
- Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA.
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Xirou V, Xirou T, Siganos C, Ntonti P, Georgakopoulos C, Stavrakas P, Makri OE, Kanakis M, Tsapardoni F, Fragkoulis I, Garnavou-Xirou C, Kozobolis V. Impact of Cataract Surgery on IOP and Ocular Structures in Normotensive Patients and Primary and Exfoliation Open-Angle Glaucoma Patients. Clin Ophthalmol 2023; 17:1047-1055. [PMID: 37041963 PMCID: PMC10083030 DOI: 10.2147/opth.s402550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023] Open
Abstract
Purpose The aim of this study was to evaluate and compare the changes in Intraocular Pressure (IOP) and other ocular parameters: the Anterior Chamber Angle (ACA), Anterior Chamber Volume (ACV), and Anterior Chamber Depth (ACD) during phacoemulsification surgery in Greek patients with normotensive eyes and those with well-controlled Open-Angle Glaucoma (OAG). Additionally, parameters such as the Corneal Thickness (CCT), Axial Length (AL), Central Macular Thickness (CMT), and Retinal Nerve Fibre Layer (RNFL) were also examined. Patients and Methods This was a prospective observational case-control study that included 50 phakic eyes, 25 normotensive (Group 1), and 25 with OAG: 15 Primary Open-Angle Glaucoma (POAG) and 10 Exfoliation Glaucoma (EXG) (Group 2). Ophthalmic assessment included IOP measurements, ocular biometry, and anterior and posterior segment optical coherence tomography evaluation of the aforementioned ocular parameters, prior and 6 months after phacoemulsification surgery. Results At the 6 months post-operative review, a greater IOP reduction was recorded in eyes with OAG, in comparison to normotensive ones (5.3mmHg and 1.6 mmHg respectively). In addition, a significant but similar increase was recorded in the values of the ACA, ACV, and ACD of both groups between the pre- and the post-op period. Furthermore, the CCT and AL values remained unaltered. Finally, there was a non-statistically significant change in the mean CMT and the mean average RNFL of both groups. Conclusion Eyes with OAG tend to undergo a greater reduction in IOP post-phacoemulsification surgery, in comparison to normotensive eyes. This reduction may not be solely attributed to ocular anatomical changes after phacoemulsification surgery but may also be due to the remodeling of the trabecular meshwork and the ciliary body. This may be especially true in the case of OAG eyes, which already start off with a compromised trabecular endothelium prior to surgery.
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Affiliation(s)
- Vasiliki Xirou
- Ophthalmology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece
- Correspondence: Vasiliki Xirou, Ophthalmology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece, Email
| | - Tina Xirou
- Ophthalmology Department, Hellenic Red Cross Hospital of Athens, Athens, Greece
| | - Charalambos Siganos
- Ophthalmology Department, University Hospital of Heraklion, Heraklion, Greece
| | - Panagiota Ntonti
- Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | | | - Olga E Makri
- Ophthalmology Department, University Hospital of Patras, Patras, Greece
| | - Menelaos Kanakis
- Ophthalmology Department, University Hospital of Patras, Patras, Greece
| | | | | | | | - Vassilios Kozobolis
- Ophthalmology Department, University Hospital of Alexandroupolis, Alexandroupolis, Greece
- Ophthalmology Department, University Hospital of Patras, Patras, Greece
- Eye Institute of Thrace, Democritus University of Thrace, Alexandroupolis, Greece
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Liu Z, Yu C, Song Y, Pang M, Jin Y. The Clinical Guiding Role of the Distribution of Corneal Nerves in the Selection of Incision for Penetrating Corneal Surgery in Canines. Vet Sci 2021; 8:vetsci8120313. [PMID: 34941840 PMCID: PMC8704701 DOI: 10.3390/vetsci8120313] [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: 10/24/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
The cornea is one of the regions with the highest density of nerve terminals in the animal body and it bears such functions as nourishing the cornea and maintaining corneal sensation. In veterinary clinical practice, the corneoscleral limbus incision is frequently applied in cataract surgery, peripheral iridectomy, and other procedures for glaucoma. Inevitably, it would cause damage to the nerve roots that enter the cornea from the corneal limbus, thus inducing a series of complications. In this paper, the in vitro cornea (39 corneas from 23 canines, with ages ranging from 8 months old to 3 years old, including 12 male canines and 11 female canines) was divided into 6 zones, and the whole cornea was stained with gold chloride. After staining, corneal nerves formed neural networks at different levels of cornea. There was no significant difference in the number of nerve roots at the corneoscleral limbus between different zones (F = 1.983, p = 0.082), and the nerve roots at the corneoscleral limbus (mean value, 24.43; 95% CI, 23.43-25.42) were evenly distributed. Additionally, there was no significant difference in the number of corneal nerve roots between male and female canines (p = 0.143). There was also no significant difference in the number of corneal nerve roots between adult canines and puppies (p = 0.324). The results of the above analysis will provide a reasonable anatomical basis for selecting the incision location and orientation of penetrating surgery for the canine cornea in veterinary practice.
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Kumar CM, Chua AWY, Imani F, Sehat-Kashani S. Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review. Anesth Pain Med 2021; 11:e118271. [PMID: 34692445 PMCID: PMC8520679 DOI: 10.5812/aapm.118271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 01/28/2023] Open
Abstract
Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.
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Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Alfred W. Y. Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saloome Sehat-Kashani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Pakuliene G, Kuzmiene L, Siesky B, Harris A, Januleviciene I. 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] [MESH Headings] [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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Affiliation(s)
- Giedre Pakuliene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Eiveniu g. 2, 50161, Kaunas, Lithuania.
| | - Loreta Kuzmiene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Eiveniu g. 2, 50161, Kaunas, Lithuania
| | - Brent Siesky
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ingrida Januleviciene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Eiveniu g. 2, 50161, Kaunas, Lithuania
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Bodla MA, Bodla AA, Moazzam A, Tariq N. Correlation between changes in intraocular pressure and refractive error indices post Cataract Surgery. Pak J Med Sci 2020; 36:574-577. [PMID: 32292474 PMCID: PMC7150375 DOI: 10.12669/pjms.36.3.1597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the correlation between refractive errors and change in intraocular pressure in patients undergoing cataract surgery. Methods: This interventional retrospective case study was carried out from September 2018 to April 2019 at Bodla Eye Care and Multan Medical and Dental College, Multan. A total of 127 eyes were recruited in the study among which six were excluded. Out of remaining 121, 53 eyes were emmetropes, 41 were mild myopes and 27 were high myopes. Single surgeon performed the procedure. Pre-operative investigations of IOP and refractive error were done by goldmann tonometry and auto refractometry. IOP was reviewed at day 1, 7, 14 and 28 post cataract surgeries. Results: Out of 121 eyes, 53 eyes were emmetropes, 41 were mild myopes and 27 were high myopes, who underwent phacoemulsification. There was an elevation of 2-3mm Hg at Day-1, in emmetropes and mild myopes, and further on, a constant drop was noticed on follow ups. In high myopes a significant fluctuation of IOP was noted in first fourteen days followed by an unremarkable gradual decline afterwards. Conclusion: Cataract surgery helps lowering the IOP in patients with refractive errors. Mild myopic and emmetropic patients showed a linear swift pattern while high myopes presented instable and gradual reduction in IOP. A total decrease of 1-2mm Hg was seen at the end of the study depicting that relation between IOP and cataract surgery is insignificant.
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Affiliation(s)
- Muhammad Afzal Bodla
- Muhammad Afzal Bodla, DORCS. Department of Ophthalmology, Multan Medical and Dental College Multan, Pakistan
| | - Ali Afzal Bodla
- Ali Afzal Bodla, FRCS. Department of Ophthalmology, Multan Medical and Dental College Multan, Pakistan
| | - Ayema Moazzam
- Ayema Moazzam, Department of Ophthalmology, Multan Medical and Dental College Multan, Pakistan
| | - Noor Tariq
- Noor Tariq, Department of Ophthalmology, Multan Medical and Dental College Multan, Pakistan
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Jones JH, Aldwinckle R. Perioperative Dexmedetomidine for outpatient cataract surgery: a systematic review. BMC Anesthesiol 2020; 20:75. [PMID: 32247310 PMCID: PMC7126406 DOI: 10.1186/s12871-020-00973-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/28/2020] [Indexed: 11/12/2022] Open
Abstract
Background Cataract surgery is one of the most common procedures performed worldwide in the elderly. Various medications can provide effective anesthesia and analgesia for cataract surgery, but undesirable side effects limit the utility of each medication or combination of medications. Dexmedetomidine may serve as an anesthesia adjunct for outpatient cataract surgery in the elderly. Methods Searches were conducted in Cochrane, Embase, and PubMed for randomized clinical trials investigating the use of dexmedetomidine in adult patients undergoing outpatient, or ambulatory, cataract surgery with sedation and topical or peribulbar block. Ninety-nine publications were identified, of which 15 trials satisfied the inclusion criteria. A total of 914 patients were included in this review. The following data were collected: American Society of Anesthesiologists’ (ASA) physical status and age of study patients; method of blinding and randomization; medication doses and routes of administration; and intraoperative levels of sedation. We also recorded statistically significant differences between dexmedetomidine and other study medications or placebo with respect to the following outcomes: hemodynamic and respiratory parameters; pain; sedation; post-operative nausea and vomiting (PONV); discharge from post-anesthesia care unit (PACU) or recovery times; patient satisfaction; surgeon satisfaction; and effects on intraocular pressure (IOP). Results Hypotension with or without bradycardia was reported following bolus doses of dexmedetomidine ranging from 0.5–1.0 mcg/kg with or without a continuous dexmedetomidine infusion. Delayed PACU discharge times were associated with the use of dexmedetomidine, but no clear association was identified between delayed recovery and higher levels of intraoperative sedation. Better analgesia and higher patient satisfaction were commonly reported with dexmedetomidine as well as reductions in IOP. Conclusions Overall, this review demonstrates better analgesia, higher patient satisfaction, and reduced IOP with dexmedetomidine for outpatient cataract surgery when compared to traditional sedatives, hypnotics, and opioids. These benefits of dexmedetomidine, however, must be weighed against relative cardiovascular depression and delayed PACU discharge or recovery times. Therefore, the utility of dexmedetomidine for outpatient cataract surgery should be considered on a patient-by-patient basis.
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Affiliation(s)
- James Harvey Jones
- UC Davis Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA.
| | - Robin Aldwinckle
- UC Davis Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 4150 V Street, PSSB Suite 1200, Sacramento, CA, 95817, USA
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Maloley LA, Razeghinejad MR, Havens SJ, Gulati V, Fan S, High R, Ghate DA. Pneumotonometer Accuracy Using Manometric Measurements after Radial Keratotomy, Clear Corneal Incisions and Lamellar Dissection in Porcine Eyes. Curr Eye Res 2019; 45:1-6. [PMID: 31380714 DOI: 10.1080/02713683.2019.1652915] [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: 10/26/2022]
Abstract
Purpose/Aim of the study: Measured intraocular pressure (IOP) after corneal incisions may not be reflective of the true IOP because of changes in corneal biomechanical properties. The purpose of this study is to investigate the effect of various corneal incisions on pneumotonometer accuracy in enucleated porcine eyes.Materials and Methods: A pneumotonometer was used to measure IOP (IOPp) at manometrically controlled pressure levels of 10, 20, 30 and 40 mmHg in enucleated porcine eyes. IOP measurements at each level were repeated after one of the following corneal incisions: radial keratotomy (8 eyes), lamellar dissection (10 eyes), clear cornea standard phacoemulsification incisions (10 eyes). The pneumotonometer error, defined as the difference between IOPp and manometric pressure (IOPm), was calculated for each pressure level. The error before the corneal incisions was compared to the error after the corneal incisions to assess the accuracy of the pneumotonometer.Results: The pneumotonometer underestimates true IOP at all pressure levels, both before and after the corneal procedures. There was a statistically significant greater underestimation of IOP after radial keratotomy incisions at pressure levels of 20, 30 and 40 mmHg (p = .013, 0.004, and 0.002, respectively). There was no statistically significant difference in the amount of pneumotonometer underestimation error after lamellar dissection or standard cataract incisions.Conclusion: The pneumotonometer underestimates true IOP in enucleated porcine eyes at all pressure levels between 10-40 mmHg. Radial keratotomy incisions caused a statistically significant greater underestimation error in pneumotonometry measurements at pressures of 20-40 mmHg. Lamellar dissection and clear corneal cataract incisions did not cause an additional error in pneumotonometry measurements in enucleated porcine eyes.
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Affiliation(s)
- Lauren A Maloley
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Shane J Havens
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Vikas Gulati
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shan Fan
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robin High
- Department of Statistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Deepta A Ghate
- Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
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12
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Kovacic H, Wolfs RCW, Kılıç E, Ramdas WD. Changes in intraocular pressure after intraocular eye surgery-the influence of measuring technique. Int J Ophthalmol 2019; 12:967-973. [PMID: 31236354 DOI: 10.18240/ijo.2019.06.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/06/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the changes in intraocular pressure (IOP) before and after intraocular surgery measured with Goldmann applanation tonometry (GAT) and pascal dynamic contour tonometry (PDCT), and assessed their agreement. METHODS Patients who underwent trans pars plana vitrectomy (TPPV) with or without cataract extraction (CE) were included. The IOP was measured in both eyes with GAT and PDCT pre- and postoperatively, where the non-operated eyes functioned as control. RESULTS Preoperatively, mean IOP measurements were 16.3±6.0 mm Hg for GAT and 12.0±2.8 mm Hg for PDCT for the operated eyes. Postoperatively, the mean IOP dropped to 14.3±5.6 mm Hg for GAT (P=0.011) and rose up to 12.7±2.6 mm Hg for PDCT (P=0.257). Bland-Altman analysis showed a poor agreement between GAT and PDCT with a mean difference of 2.9 mm Hg preoperatively and 95% limits of agreement ranging from -3.2 to 9.0 mm Hg. Postoperatively, the mean difference was 1.2 mm Hg with 95% limits of agreement ranging from -8.3 to 10.7 mm Hg. There were no significant differences between the TPPV and TPPV+CE group, except when measured with PDCT postoperatively (P=0.012). CONCLUSION The IOP is reduced after surgery when measured with GAT and remained stable when measured with PDCT. However, the agreement between GAT and PDCT is poor. Although PDCT may be a more accurate predictor of the true IOP, it seems less suitable for daily use in the clinical practice.
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Affiliation(s)
- Hrvoje Kovacic
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam 3000 CA, the Netherlands
| | - Roger C W Wolfs
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam 3000 CA, the Netherlands
| | - Emine Kılıç
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam 3000 CA, the Netherlands
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam 3000 CA, the Netherlands
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13
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Perez CI, Chansangpetch S, Nguyen A, Feinstein M, Mora M, Badr M, Masis M, Porco T, Lin SC. How to Predict Intraocular Pressure Reduction after Cataract Surgery? A Prospective Study. Curr Eye Res 2019; 44:623-631. [PMID: 30747546 DOI: 10.1080/02713683.2019.1580375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose/Aim: To evaluate the best formula to predict intraocular pressure (IOP) reduction after cataract surgery. Materials and methods: In this prospective longitudinal study, we included consecutive patients with or without glaucoma, either with open or with narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Clinical factors and anterior segment parameters measured with optical biometry and optical coherence tomography were evaluated as preoperative predictors for IOP reduction at 6 months postoperatively. To find the best combinations of predictors, model selection was conducted using least absolute selection and shrinkage operator regression with cross-validation. Results: A total of 156 eyes from 109 patients were enrolled. The mean age of the patients was 74.89 (±8.54) years and the average preoperative IOP was 15.6 (±3.68) mmHg with 0.7 (range 0-4) glaucoma medications. The mean IOP reduction after phaco was 3.1 (±2.49) mmHg at postoperative month 6. After multivariate analysis, preoperative IOP (β = 0.49 [0.4-0.59] P < .0001), gonioscopy score (β = -0.14 [-0.23 to -0.06] P = .0001), anterior chamber depth (β = -0.85 [-1.64 to -0.07] P = 0.033), lens thickness (LT) (β = 0.87 [0.12-1.62] P = .024), and angle open distance 750 (β = -2.2 [-3.96 to -0.44] P = 0.014) were associated with IOP reduction. The best formula to correlate with IOP reduction was -4.76 + (0.46 × preoperative IOP) - (0.42 × LT) - (0.1 × gonioscopy score) - (0.66 × glaucoma status). Conclusion: Different formulas were developed and were able to improve the predictive value of the preoperative IOP. When used in combination, these formulas may help the clinician to know how much IOP reduction to expect after cataract surgery at 6 months postoperatively.
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Affiliation(s)
- Claudio I Perez
- a Department of Ophthalmology , University of California , San Francisco , CA , USA.,b Fundación Oftalmológica los Andes , Universidad de los Andes , Santiago , Chile
| | - Sunee Chansangpetch
- a Department of Ophthalmology , University of California , San Francisco , CA , USA.,c Faculty of Medicine , Chulalongkorn University, and King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Anwell Nguyen
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Max Feinstein
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Marta Mora
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Mai Badr
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Marisse Masis
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Travis Porco
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
| | - Shan C Lin
- a Department of Ophthalmology , University of California , San Francisco , CA , USA
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14
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Mahdavi Fard A, Patel SP, Pourafkari L, Nader ND. Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis. Ther Adv Chronic Dis 2019; 10:2040622318820850. [PMID: 30728930 PMCID: PMC6357298 DOI: 10.1177/2040622318820850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 09/24/2018] [Indexed: 11/15/2022] Open
Abstract
Bacground The aim of this study was to conduct a meta-analysis to compare the overall intraocular pressure (IOP)-lowering effect of iStent or CyPass as isolated procedures or in combination with cataract extraction. Materials and methods Cochrane review manager 5.3 software (RevMan® 5.3) was used for a meta-analysis of IOPs and the number of antiglaucoma medications in six groups according to the type and number of stents and whether the procedure was isolated or in combination with cataract extraction. Main results A total of 33 out of 446 publications retrieved have been enrolled. The mean changes in IOP in the groups with one iStent and more than two iStents with concurrent cataract extraction were -3.78 ± 0.53 mmHg and -3.89 ± 0.73 mmHg, respectively. The mean differences in IOP in the groups with one iStent and more than two iStents without concurrent cataract extraction were -3.96 ± 0.25 mmHg and -7.48 ± 0.55 mmHg, respectively. The mean changes in IOP in the groups with CyPass implantation with and without concurrent cataract extraction were -4.97 ± 1.38 mmHg and -8.96 ± 0.16 mmHg, respectively. Conclusions Both iStent and CyPass either in combination with cataract extraction or as isolated procedures effectively decrease IOP. This effect is greatest with isolated implantation of CyPass followed by multiple iStents and then single iStent implantation and lasts up to 2 years.
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Affiliation(s)
- Ali Mahdavi Fard
- Department of Ophthalmology, University at Buffalo, Buffalo, NY, USA Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sangita P Patel
- Department of Ophthalmology, Ross Eye Institute, The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA Ophthalmology and Research Service, Veterans Administration Western New York Healthcare, System, Buffalo, NY, USA SUNY Eye Institute, Buffalo, NY, USA
| | | | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, 77 Goodell Street, Suite #550, Buffalo, NY 14203, USA
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15
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Park Y, Kim YB, Cho KJ. Effect of Preoperative Factors and Gonioscopy on Intraocular Pressure Reduction after Phacoemulsification in Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.5.463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yuli Park
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Young Bin Kim
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea
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16
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Tojo N, Otsuka M, Hayashi A. Comparison of intraocular pressure fluctuation before and after cataract surgeries in normal-tension glaucoma patients. Eur J Ophthalmol 2018; 29:516-523. [DOI: 10.1177/1120672118801163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Cataract surgeries have been shown to reduce intraocular pressure. We used a Sensimed Triggerfish® contact lens sensor to compare intraocular pressure levels and their fluctuation between before and after cataract surgeries in patients with normal-tension glaucoma. Methods: This was a prospective open-label study. Thirteen patients with normal-tension glaucoma were included. All patients underwent a 1-month washout and discontinued glaucoma medications during this study. In each eye, intraocular pressure fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the cataract surgery. We compared intraocular pressure levels and their fluctuation between before and after cataract surgeries. We used two approaches to evaluate the amplitude of intraocular pressure fluctuations: dual-harmonic regression analysis, and measurement of the difference between the maximum and the minimum value. Results: The mean pre-operative intraocular pressure was 14.7 ± 2.2 mm Hg and mean post-operative intraocular pressure was 11.4 ± 2.2 mm Hg. Cataract surgery significantly decreased intraocular pressure (p = 0.0005). In both methods, the post-operative fluctuations in intraocular pressure over 24 h were significantly smaller than their pre-operative counterparts (dual-harmonic regression analysis: p = 0.0171; difference between the maximum and the minimum: p = 0.0398). Conclusion: Cataract surgery decreased both intraocular pressure values and intraocular pressure fluctuations in normal-tension glaucoma patients.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences for Education, University of Toyama, Toyama, Japan
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences for Education, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences for Education, University of Toyama, Toyama, Japan
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17
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Lv H, Yang J, Liu Y, Jiang X, Liu Y, Zhang M, Wang Y, Song H, Li X. Changes of intraocular pressure after cataract surgery in myopic and emmetropic patients. Medicine (Baltimore) 2018; 97:e12023. [PMID: 30235658 PMCID: PMC6160148 DOI: 10.1097/md.0000000000012023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To investigate the intraocular pressure (IOP) changes after cataract surgery, and its relationship with refractive conditions.IOP after phacoemulsification with intraocular lens (IOL) implantation was retrospectively reviewed. Patients were classified into 3 groups by refractive conditions: emmetropia, mild to moderate myopia, and high myopia. Basic information was collected including age, sex, place of IOL, and operating surgeon, with IOP and refractive conditions measured before surgery, and 1, 7, 30, and 90 days after surgery.The study comprised 353 eyes from 353 patients, of which 175 were emmetropia, 130 were mild to moderate myopia, and 48 were high myopia. A lower IOP than baseline was observed at 7, 30, and 90 days after surgery in emmetropic and mild to moderate myopia, while in high myopia, IOP was instable from 1 to 30 days, and reduced only in 90 days after surgery. Changes of IOP was more significant from 1 to 7 days in emmetropic and mild to moderate myopic patients, but from 30 to 90 days in high myopia. Patients over 75 showed a lower IOP at each follow-up than patients younger and female showed a higher baseline IOP than male. Different surgeons might influence the IOP fluctuation at first 90 days but not the final IOP.All patients with different refractive conditions showed a remarkably lower IOP at 90 days after cataract surgery. However, high myopia lowered the speed of IOP reduction, which might be explained by the anatomical changes of eye structure.
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18
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Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification. J Glaucoma 2018; 27:622-626. [DOI: 10.1097/ijg.0000000000000976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Alaghband P, Beltran-Agulló L, Galvis EA, Overby DR, Lim KS. Effect of phacoemulsification on facility of outflow. Br J Ophthalmol 2018; 102:1520-1526. [PMID: 29654113 PMCID: PMC6241621 DOI: 10.1136/bjophthalmol-2017-311548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/15/2018] [Accepted: 01/19/2018] [Indexed: 11/24/2022]
Abstract
Purpose Phacoemulsification has been shown to reduce intraocular pressure (IOP). The mechanism of action is thought to be via increased trabecular outflow facility. However, studies on the relationship between phacoemulsification and outflow facility have been inconsistent. This study intended to examine the change in electronic Schiotz tonographic outflow facility (TOF) and IOP measurements following phacoemulsification. Methods Patients who were due to undergo a standard clear corneal incision phacoemulsification with intraocular lens (IOL) implantation, at St Thomas’ Hospital, were invited to participate in this study. IOP was measured using Goldmann’s applanation tonometer, and TOF was measured by electronic Schiotz tonography at baseline and at 3, 6 and 12 months postoperatively. Results Forty-one patients were recruited. Tonography data for 27 patients were reliable and available at all time points. Eleven cases had primary open angle glaucoma and cataract, while 16 patients had cataract only. Mean IOP reduced at every time point postoperatively significantly compared with baseline. TOF improved significantly after cataract extraction at all time points (baseline of 0.14±0.06 vs 0.18±0.09 at 3 months, P=0.02 and 0.20±0.09 at 6 months, P=0.003, 0.17±0.07 µL/min mmHg at 12 months, P=0.04). Five contralateral eyes of patients with cataracts only who did not have any intraocular surgery during the follow-up period were used as comparison. Their IOP and TOF did not change significantly at any postoperative visits. Conclusion This is the first study using electronic Schiotz tonography with documented anterior chamber depth and gonioscopy after modern cataract surgery (CS) with phacoemulsification and IOL implantation. We demonstrated that phacoemulsification increases TOF and this fully accounts for the IOP reduction following CS. ISTCRN registration number ISRCTN04247738.
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Affiliation(s)
- Pouya Alaghband
- Ophthalmology, St Thomas' Hospital, London, UK.,Academic ophthalmology, King's College London, London, UK
| | - Laura Beltran-Agulló
- Ophthalmology, St Thomas' Hospital, London, UK.,Ophthalmology, Institut Català de la Retina, Barcelona, Spain
| | | | - Darryl R Overby
- Department of Bioengineering, Imperial College London, London, UK
| | - Kin Sheng Lim
- Ophthalmology, St Thomas' Hospital, London, UK.,Academic ophthalmology, King's College London, London, UK
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20
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Park Y, Moon JI, Cho KJ. The Effect of Intraoperative Factors on Intraocular Pressure Reduction after Phacoemulsification in Open-angle Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yuli Park
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jung Il Moon
- Department of Ophthalmology, Yeouido St.Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyong Jin Cho
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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21
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Role of lens extraction and laser peripheral iridotomy in treatment of glaucoma. Curr Opin Ophthalmol 2018; 29:96-99. [DOI: 10.1097/icu.0000000000000435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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The Effects of Phacoemulsification on Intraocular Pressure and Topical Medication Use in Patients With Glaucoma: A Systematic Review and Meta-analysis of 3-Year Data. J Glaucoma 2017; 26:511-522. [PMID: 28333892 DOI: 10.1097/ijg.0000000000000643] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE For patients with comorbid cataract and primary open-angle glaucoma (POAG), guidance is lacking as to whether cataract extraction and traditional filtering surgery should be performed as a staged or combined procedure. Achieving this guidance requires an evidence-based understanding of the effects of phacoemulsification alone on intraocular pressure (IOP) in patients with POAG. For this reason, a systematic review and meta-analysis was undertaken to synthesize evidence quantifying the effect of phacoemulsification on IOP and the required number of topical glaucoma medications in patients with cataract and POAG. MATERIALS AND METHODS Database searches were last run on August 15, 2016 to identify potentially relevant studies. Identified articles were screened for relevance and meta-analysis was used to compute postoperative mean and percentage reduction in IOP (IOPR%) as well as mean difference in topical glaucoma medications. RESULTS The search strategy identified 1613 records. Thirty-two studies (1826 subjects) were included in quantitative synthesis. A 12%, 14%, 15%, and 9% reduction in IOP from baseline occurred 6, 12, 24, and 36 months after phacoemulsification. A mean reduction of 0.57, 0.47, 0.38, and 0.16 medications per patient of glaucoma medication occurred 6, 12, 24, and 36 months after phacoemulsification. CONCLUSIONS Phacoemulsification as a solo procedure does lower IOP in patients with POAG, and reduces dependency on topical glaucoma medications. These effects appear to last at least 36 months with gradual loss of the initial effect noted after 2 years. Certain populations appear to experience much greater reductions in IOP than others and future work to identify these high responding patients is needed.
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23
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Jimenez-Roman J, Lazcano-Gomez G, Martínez-Baez K, Turati M, Gulías-Cañizo R, Hernández-Zimbrón LF, Ochoa-De la Paz L, Zamora R, Gonzalez-Salinas R. Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma. Int J Ophthalmol 2017; 10:1374-1378. [PMID: 28944195 DOI: 10.18240/ijo.2017.09.07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. RESULTS The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. CONCLUSION In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.
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Affiliation(s)
- Jesus Jimenez-Roman
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Gabriel Lazcano-Gomez
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Karina Martínez-Baez
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Mauricio Turati
- Glaucoma Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Rosario Gulías-Cañizo
- Research Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico.,Cell Biology Department, Advanced Research Center, I.P.N. (CINVESTAV) in Mexico City, Mexico City 07360, Mexico
| | | | - Lenin Ochoa-De la Paz
- Research Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
| | - Rubén Zamora
- Research Department, Asociation to Prevent Blindness in Mexico, Mexico City 04030, Mexico
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24
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Lee W, Bae HW, Lee SH, Kim CY, Seong GJ. Correlations between Preoperative Angle Parameters and Postoperative Unpredicted Refractive Errors after Cataract Surgery in Open Angle Glaucoma (AOD 500). Yonsei Med J 2017; 58:432-438. [PMID: 28120576 PMCID: PMC5290025 DOI: 10.3349/ymj.2017.58.2.432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/07/2016] [Accepted: 10/15/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the accuracy of intraocular lens (IOL) power prediction for cataract surgery with open angle glaucoma (OAG) and to identify preoperative angle parameters correlated with postoperative unpredicted refractive errors. MATERIALS AND METHODS This study comprised 45 eyes from 45 OAG subjects and 63 eyes from 63 non-glaucomatous cataract subjects (controls). We investigated differences in preoperative predicted refractive errors and postoperative refractive errors for each group. Preoperative predicted refractive errors were obtained by biometry (IOL-master) and compared to postoperative refractive errors measured by auto-refractometer 2 months postoperatively. Anterior angle parameters were determined using swept source optical coherence tomography. We investigated correlations between preoperative angle parameters [angle open distance (AOD); trabecular iris surface area (TISA); angle recess area (ARA); trabecular iris angle (TIA)] and postoperative unpredicted refractive errors. RESULTS In patients with OAG, significant differences were noted between preoperative predicted and postoperative real refractive errors, with more myopia than predicted. No significant differences were recorded in controls. Angle parameters (AOD, ARA, TISA, and TIA) at the superior and inferior quadrant were significantly correlated with differences between predicted and postoperative refractive errors in OAG patients (-0.321 to -0.408, p<0.05). Superior quadrant AOD 500 was significantly correlated with postoperative refractive differences in multivariate linear regression analysis (β=-2.925, R²=0.404). CONCLUSION Clinically unpredicted refractive errors after cataract surgery were more common in OAG than in controls. Certain preoperative angle parameters, especially AOD 500 at the superior quadrant, were significantly correlated with these unpredicted errors.
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Affiliation(s)
- Wonseok Lee
- Department of Ophthalmology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hyoung Won Bae
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Si Hyung Lee
- Department of Ophthalmology, Eulji University Hospital, Daejeon, Korea
| | - Chan Yun Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Gong Je Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
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25
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DeVience E, Chaudhry S, Saeedi OJ. Effect of intraoperative factors on IOP reduction after phacoemulsification. Int Ophthalmol 2016; 37:63-70. [PMID: 27061903 DOI: 10.1007/s10792-016-0230-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/04/2016] [Indexed: 11/29/2022]
Abstract
The purpose of the study was to determine the independent predictors of long-term intraocular pressure (IOP) reduction after cataract surgery with phacoemulsification. This is a retrospective review of uncomplicated cataract surgeries from 2006 to 2008 at the Baltimore VA Medical Center with longitudinal follow-up. Demographic, clinical, biometric, and intraoperative variables including phacoemulsification parameters were recorded. Univariate and multivariate linear regression were used to analyze the relationship between these variables and postoperative IOP, which was the outcome variable. Analysis was performed in 115 eyes of 115 patients who underwent uncomplicated phacoemulsification during the study period. There was an average postoperative IOP reduction through 12, 24, and 36 months of -1.7 ± 3.1, -1.5 ± 3.8, and -1.3 ± 2.6 mmHg, respectively. Higher preoperative IOP (P < 0.001), a more anterior relative lens position (P < 0.05), and longer phaco time (P < 0.05) were significantly associated with greater postoperative decrease in IOP using univariate analysis. Using multivariate analysis, preoperative IOP (P < 0.001), and phaco time (P = 0.038) were associated with greater postoperative IOP reduction through 24 months. Phaco time is independently associated with IOP reduction after adjusting for age and preoperative IOP. Higher preoperative IOP is associated with a greater IOP-lowering effect after phacoemulsification.
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Affiliation(s)
- Eva DeVience
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St, Suite 470, Baltimore, MD, 21201, USA
| | - Sona Chaudhry
- Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St, Suite 470, Baltimore, MD, 21201, USA.
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Turk A, Ceylan OM, Gokce G, Borazan M, Kola M. Comparison of brimonidine-timolol and dorzolamide-timolol in the management of intraocular pressure increase after phacoemulsification. Int J Ophthalmol 2015; 8:945-9. [PMID: 26558206 DOI: 10.3980/j.issn.2222-3959.2015.05.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/02/2015] [Indexed: 11/02/2022] Open
Abstract
AIM To compare the effectiveness of brimonidine/timolol fixed combination (BTFC) and dorzolamide/timolol fixed combination (DTFC) in the management of short-term intraocular pressure (IOP) increase after phacoemulsification surgery. METHODS Eighty eyes of 80 patients undergoing phacoemulsification and intraocular lens (IOL) implantation were randomly assigned into three groups. Group 1 consisted of 28 eyes and represented the control group. Group 2 consisted of 25 eyes undergoing phacoemulsification surgery and BTFC was instilled at the end of surgery. Group 3 consisted of 27 eyes undergoing phacoemulsification surgery and DTFC was instilled at the end of surgery. IOP was measured preoperatively and 6, 24h and 1wk postoperatively. RESULTS There was no statistically significant difference in preoperative baseline IOP among the three groups (P=0.84). However, IOP was significantly lower in groups 2 and 3 compared to the control group (P<0.05 for all comparisons) at all postoperative visits. There was no significant difference between groups 2 and 3 at any visit. Eight eyes (28.6%) in the control group, two (8%) in Group 2 and one (3.7%) in Group 3 had IOP >25 mm Hg at 6h after surgery (P=0.008). However, IOP decreased and was >25 mm Hg in only one eye in each group at 24h after surgery. CONCLUSION BTFC and DTFC have similar effects in reducing increases in IOP after phacoemulsification surgery and can both be recommended for preventing IOP spikes after such surgery.
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Affiliation(s)
- Adem Turk
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey
| | - Osman Melih Ceylan
- Department of Ophthalmology, Medical Park Hospital, Ankara 06370, Turkey
| | - Gokcen Gokce
- Department of Ophthalmology, Kayseri Military Hospital, Kayseri 38100, Turkey
| | - Mehmet Borazan
- Department of Ophthalmology, Faculty of Medicine, Mevlana University, Konya 42003, Turkey
| | - Mehmet Kola
- Department of Ophthalmology, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Turkey
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Abstract
PURPOSE To evaluate changes in ocular biometric parameters with optical biometry and intraocular pressure (IOP) by Goldmann tonometry after uneventful phacoemulsification in normotensive eyes. METHODS This prospective study was composed of 117 eyes of 117 patients who had undergone uncomplicated phacoemulsification and foldable intraocular lens implantation. The measurements were obtained preoperatively and 1 month postoperatively. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), pupil diameter (PD), and lens thickness were measured by the LenStar optical biometer, and IOP was measured by Goldmann applanation tonometry. The relationships between IOP change and ocular biometric parameters were evaluated. RESULTS Mean age was 64.73 ± 10.83 years; 45 patients were women (38.46%) and 72 patients were men (61.54%). Comparing preoperative and postoperative 1-month measurements, the mean AL, PD, and IOP decreased (p < 0.01), whereas ACD (p < 0.01) and CCT (p > 0.05) increased. Intraocular pressure change correlated positively with AL change (p < 0.05) and PD change (p < 0.05) and preoperative IOP (p < 0.01) and preoperative CCT (p < 0.05). Anterior chamber depth change correlated positively with preoperative ACD (p < 0.01) and negatively with preoperative PD (p < 0.05). Pupil diameter change positively correlated with preoperative PD (p < 0.01). Regression analyses showed that preoperative IOP significantly associated with postoperative IOP reduction according to the standardized coefficient beta (-0.649). CONCLUSIONS Anterior segment morphometry changed and IOP decreased after phacoemulsification. The preoperative IOP may be the best parameter for estimating postoperative IOP reduction.
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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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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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