Effect of Phacoemulsification on Intraocular Pressure in Healthy Subjects and Glaucoma Patients

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Abstract

Background

We investigated how cataract surgery might influence long-term intraocular pressure (IOP) change in both healthy subjects and glaucoma patients.

Methods

A retrospective analysis of patients who had had clear corneal phacoemulsification with a minimum of 12 months of follow up was performed. Glaucoma patients with medically controlled open-angle glaucoma and healthy subjects with no glaucoma were included in the analysis. The change of IOP after phacoemulsification and factors associated with postoperative IOP change were investigated.

Results

In total, 754 eyes of 754 patients, specifically 106 patients with glaucoma and 648 patients with no glaucoma (i.e., healthy subjects) were enrolled. The phacoemulsification effected a reduction of IOP: 1.03 ± 3.72 mmHg in healthy subjects and 1.08 ± 3.79 mmHg in glaucoma patients at postoperative 1 year ( P = 0.656). There were negative coefficients of IOP until 1 year of follow up (all P < 0.001), but the IOP change gradually showed a less steeply decreasing slope (correlation coefficient: −0.993), compared with those for 1 week and 1 month of follow up (correlation coefficients: −1.893 and −1.540, respectively). In the multivariate analysis, age and preoperative IOP showed significant associations with postoperative IOP change (regression coefficients: −0.034 and 0.419 respectively, all P < 0.001).

Conclusion

Phacoemulsification resulted in IOP reduction, which effect regressed in healthy subjects and glaucoma patients over the course of long-term follow up. Therefore, long-term monitoring of IOP change is needed. In cases of higher preoperative IOP and young patients, phacoemulsification alone is a reliable option for IOP control.

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Most cited references 35

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Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract.

Thomas W Samuelson, L. Jay Katz, Jeffrey M. Wells … (2011)

To assess the safety and efficacy of the iStent trabecular micro-bypass stent (Glaukos Corporation, Laguna Hills, CA) in combination with cataract surgery in subjects with mild to moderate open-angle glaucoma. Prospective, randomized, open-label, controlled, multicenter clinical trial. A total of 240 eyes with mild to moderate open-angle glaucoma with intraocular pressure (IOP) ≤24 mmHg controlled on 1 to 3 medications were randomized to undergo cataract surgery with iStent implantation (treatment group) or cataract surgery only (control). Fifty additional subjects were enrolled to undergo cataract surgery with iStent implantation under protocol expansion. Data in this report are based on the first 240 eyes enrolled. Implantation of the iStent trabecular micro-bypass stent in conjunction with cataract surgery or cataract surgery only. The primary efficacy measure was unmedicated IOP ≤21 mmHg at 1 year. A secondary measure was unmedicated IOP reduction ≥20% at 1 year. Safety measures included best-corrected visual acuity (BCVA), slit-lamp observations, complications, and adverse events. The study met the primary outcome, with 72% of treatment eyes versus 50% of control eyes achieving the criterion (P<0.001). At 1 year, IOP in both treatment groups was statistically significantly lower from baseline values. Sixty-six percent of treatment eyes versus 48% of control eyes achieved ≥20% IOP reduction without medication (P = 0.003). The overall incidence of adverse events was similar between groups with no unanticipated adverse device effects. Pressure reduction on fewer medications was clinically and statistically significantly better 1 year after stent plus cataract surgery versus cataract surgery alone, with an overall safety profile similar to that of cataract surgery alone. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up.

E. Craven, L. Jay Katz, Jeffrey M. Wells … (2012)

To assess the long-term safety and efficacy of a single trabecular micro-bypass stent with concomitant cataract surgery versus cataract surgery alone for mild to moderate open-angle glaucoma. Twenty-nine investigational sites, United States. Prospective randomized controlled multicenter clinical trial. Eyes with mild to moderate glaucoma with an unmedicated intraocular pressure (IOP) of 22 mm Hg or higher and 36 mm Hg or lower were randomly assigned to have cataract surgery with iStent trabecular micro-bypass stent implantation (stent group) or cataract surgery alone (control group). Patients were followed for 24 months postoperatively. The incidence of adverse events was low in both groups through 24 months of follow-up. At 24 months, the proportion of patients with an IOP of 21 mm Hg or lower without ocular hypotensive medications was significantly higher in the stent group than in the control group (P=.036). Overall, the mean IOP was stable between 12 months and 24 months (17.0 mm Hg ± 2.8 [SD] and 17.1 ± 2.9 mm Hg, respectively) in the stent group but increased (17.0 ± 3.1 mm Hg to 17.8 ± 3.3 mm Hg, respectively) in the control group. Ocular hypotensive medication was statistically significantly lower in the stent group at 12 months; it was also lower at 24 months, although the difference was no longer statistically significant. Patients with combined single trabecular micro-bypass stent and cataract surgery had significantly better IOP control on no medication through 24 months than patients having cataract surgery alone. Both groups had a similar favorable long-term safety profile. Dr. Craven was an investigator in the clinical trial of the iStent. Dr. Katz is a consultant to Glaukos and was the medical monitor for the clinical trial of the iStent. Dr. Katz is a stockholder in Glaukos. Mr. Wells and Ms. Giamporcaro are employees of Glaukos. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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Prevalence of primary open-angle glaucoma in central South Korea the Namil study.

Yuong-Nam Lee, Ki Song, … (2011)

To assess the prevalence of primary open-angle glaucoma (POAG) in the Namil-myon area in central South Korea. A cross-sectional, epidemiologic study in a defined population. Residents aged ≥ 40 years in Namil-myon, a rural agricultural area in central South Korea. Each subject underwent a screening that consisted of an interview and ophthalmic examinations, including visual acuity measurement, autorefraction, anterior segment evaluation by optical biometry, slit-lamp examination, Goldmann applanation tonometry, binocular optic disc evaluation, fundus photography, pachymetry, gonioscopy, and screening visual field test using frequency doubling technology. Subjects with suspected glaucoma were referred for definitive examinations. Standard automated field tests and retinal nerve fiber layer analysis using optical coherence tomography (Stratus OCT) or scanning laser polarimetry (GDx VCC) were performed. A diagnosis of glaucoma was made based on the optic disc shape, retinal nerve fiber layer appearance, perimetric results, and other ocular findings. Prevalence of POAG, mean intraocular pressure (IOP), and mean central corneal thickness (CCT). Of 1928 eligible residents in the area, 1532 (79.5%) participated in this study. The estimated prevalence of POAG in the population aged ≥ 40 years was 3.5% (95% confidence interval [CI], 2.7%-4.3%). The prevalence of POAG with an IOP of ≤ 21 mmHg was 2.7% (95% CI, 2.1%-3.3%), and the prevalence of POAG with an IOP of ≥ 22 mmHg was 0.8% (95% CI, 0.4%-1.2%). The mean IOP for POAG eyes (16.3 ± 4.6 mmHg) was significantly higher than nonglaucomatous eyes (13.3 ± 2.7 mmHg; P = .001). The mean CCT of POAG eyes with an IOP of ≤ 21 mmHg was 528 ± 26 μm, and that of POAG eyes with an IOP ≥ 22 mmHg was 531 ± 37 μm; these values were not significantly different from that of nonglaucomatous eyes (530 ± 31 μm; P = .943 and .996, respectively). The prevalences of POAG and POAG with an IOP ≤ 21 mmHg in the Namil-myon region of central South Korea were higher than that in most previous reports worldwide, but were similar to the reported rates in black and Japanese populations. The mean IOP of POAG eyes was higher than nonglaucomatous eyes, but the mean CCTs were not different. The authors have no proprietary or commercial interest in any of the materials discussed in this article. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): J Korean Med Sci

Journal ID (iso-abbrev): J. Korean Med. Sci

Journal ID (publisher-id): JKMS

Title: Journal of Korean Medical Science

Publisher: The Korean Academy of Medical Sciences

ISSN (Print): 1011-8934

ISSN (Electronic): 1598-6357

Publication date (Electronic): 30 January 2019

Publication date Collection: 18 February 2019

Volume: 34

Issue: 6

Electronic Location Identifier: e47

Affiliations

[1 ]Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.

[2 ]Department of Ophthalmology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea.

Author notes

Address for Correspondence: Wool Suh, MD, PhD. Department of Ophthalmology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong 18450, Republic of Korea. being111@ 123456hotmail.com

Author information

Sung Uk Baek https://orcid.org/0000-0003-2419-9483

Soonil Kwon https://orcid.org/0000-0002-3124-6260

In Won Park https://orcid.org/0000-0001-9686-7386

Wool Suh https://orcid.org/0000-0002-1953-5684

Article

DOI: 10.3346/jkms.2019.34.e47

PMC ID: 6374551

PubMed ID: 30787680

SO-VID: ea213f4c-410f-4c3a-ad24-cb2081869831

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effect of Phacoemulsification on Intraocular Pressure in Healthy Subjects and Glaucoma Patients

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Background

Methods

Results

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Karger: Ophthalmology

Most cited references 35

Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract.

Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up.

Prevalence of primary open-angle glaucoma in central South Korea the Namil study.

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