Long-Term Effect of Phacoemulsification on IOP

PURPOSE

• To investigate the effect of cataract surgery by phacoemulsification on intraocular pressure (IOP) in patients with medically POAG

METHODS

• Seventy eyes of 40 POAG patients undergoing cataract surgery by phacoemulsification were retrospectively evaluated before and for 1 year after cataract surgery
• One year after phacoemulsification, IOP decreased by a mean 1.15 ± 3 mmHg (6.8 ± 18.1%) (P = 0.01) and the number of glaucoma medications remained unchanged with a difference of - 0.1 ± 0.43 (P = 0.09).
• Higher preoperative IOP was associated with a greater IOP decrease after 1 year of follow-up (P < 0.001). One and 7 days after cataract surgery, 12.9 and 4.2% of the eyes had IOP spikes > 30 mmHg, respectively.
• One year after cataract surgery, 75.7% of the POAG eyes maintained the same number of glaucoma medications while 17.1% had a decrease and 7.2% of the eyes required adding glaucoma medications.

CONCLUSION

• Cataract surgery by phacoemulsification in eyes with medically controlled POAG resulted at 1 year in a very small IOP decrease without a change in the number of glaucoma medications.
• A drop in IOP should not be expected after performing phacoemulsification alone in POAG patients.

TAKE HOME MESSAGE

• In patients with primary open-angle glaucoma (POAG) controlled on medication, the authors retrospectively evaluated the effect of cataract surgery on intraocular pressure.
• They found that, after phacoemulsification for visually significant cataract, 5% of the total 70 eyes included in the study had an increase in IOP of >5 mm Hg, 8% of the eyes had a decrease in IOP of >5 mm Hg, and 87% of the eyes had stable IOP with no change in glaucoma medications at 1 year of follow-up.
• Cataract surgery in eyes with POAG is not expected to lower IOP and could instead lead to immediate postoperative spikes as well as a sustained increase.

REFERENCE

BMC Ophthalmol 2019 Jul 12;19(1)149