Effect of phacoemulsification cataract surgery on intraocular pressure in early glaucoma: A prospective multi-site study.
biometry
cataract
cataract surgery
open-angle glaucoma
phacoemulsification
Journal
Clinical & experimental ophthalmology
ISSN: 1442-9071
Titre abrégé: Clin Exp Ophthalmol
Pays: Australia
ID NLM: 100896531
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
18
10
2019
revised:
19
01
2020
accepted:
26
01
2020
pubmed:
8
2
2020
medline:
1
9
2021
entrez:
8
2
2020
Statut:
ppublish
Résumé
Cataract and primary open-angle glaucoma (POAG) commonly co-exist, and cataract surgery is thought to reduce intraocular pressure (IOP), the major modifiable risk factor of POAG. Previous studies exploring the effect of cataract surgery on IOP are limited by retrospective design, lack of a control group, medication use and washout and loss to follow up. Prospective, multicentre, matched case-control Australian study. 171 eyes of 108 POAG patients who underwent cataract surgery, matched to 171 control eyes. Serial longitudinal IOP measurements were compared before and after cataract surgery, and relative to the controls. A mixed-effect model was used for the longitudinal data. Change in IOP. The mean follow-up time was 4.8 (1.4) years. Cataract surgery reduced mean IOP by 2.22 mmHg (95% confidence interval: 1.93-2.52 mmHg, P < .001) with 59 eyes (34%) achieving at least 3 mmHg reduction. Compared to matched controls, the mean reduction in IOP was 1.75 mmHg (95% confidence interval 1.15-2.33 mmHg; P < .001). Higher preoperative IOP and being on fewer topical glaucoma medications preoperatively were strongly predictive of a larger IOP reduction in a multivariable model. Anterior chamber depth was not associated with IOP reduction. Eyes with preoperative IOP ≥24 mmHg had a mean IOP reduction of 4.03 mmHg with 81% experiencing at least 3 mmHg reduction. Sub-analysis of medication naïve and pseudoexfoliation patients showed similar results. Cataract surgery has a confirmed effect in reducing IOP in a "real world" setting of early glaucoma patients.
Sections du résumé
IMPORTANCE
Cataract and primary open-angle glaucoma (POAG) commonly co-exist, and cataract surgery is thought to reduce intraocular pressure (IOP), the major modifiable risk factor of POAG.
BACKGROUND
Previous studies exploring the effect of cataract surgery on IOP are limited by retrospective design, lack of a control group, medication use and washout and loss to follow up.
DESIGN
Prospective, multicentre, matched case-control Australian study.
PARTICIPANTS
171 eyes of 108 POAG patients who underwent cataract surgery, matched to 171 control eyes.
METHODS
Serial longitudinal IOP measurements were compared before and after cataract surgery, and relative to the controls. A mixed-effect model was used for the longitudinal data.
MAIN OUTCOME MEASURES
Change in IOP.
RESULTS
The mean follow-up time was 4.8 (1.4) years. Cataract surgery reduced mean IOP by 2.22 mmHg (95% confidence interval: 1.93-2.52 mmHg, P < .001) with 59 eyes (34%) achieving at least 3 mmHg reduction. Compared to matched controls, the mean reduction in IOP was 1.75 mmHg (95% confidence interval 1.15-2.33 mmHg; P < .001). Higher preoperative IOP and being on fewer topical glaucoma medications preoperatively were strongly predictive of a larger IOP reduction in a multivariable model. Anterior chamber depth was not associated with IOP reduction. Eyes with preoperative IOP ≥24 mmHg had a mean IOP reduction of 4.03 mmHg with 81% experiencing at least 3 mmHg reduction. Sub-analysis of medication naïve and pseudoexfoliation patients showed similar results.
CONCLUSIONS AND RELEVANCE
Cataract surgery has a confirmed effect in reducing IOP in a "real world" setting of early glaucoma patients.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
442-449Informations de copyright
© 2020 Royal Australian and New Zealand College of Ophthalmologists.
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