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Crystalline lens could play major role in development of ocular hypertension and adult glaucoma

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CHICAGO — Phacoemulsification with IOL implantation is an effective treatment for lowering pressure in patients with ocular hypertension or glaucoma with IOPs of 20 mm Hg and higher, a researcher said here.

"Today, phaco-IOL may be the most successful, often used and unrecognized operation for ocular hypertension and glaucoma," Brooks J. Poley, MD, said at the American Society of Cataract and Refractive Surgery meeting. His presentation was named the best in the Glaucoma Surgical Treatment paper session.

Dr. Poley presented a retrospective study that he and colleagues conducted to examine IOP reductions in 124 glaucomatous eyes. Patients had visual field and/or optic nerve loss, and they were on glaucoma drops or had trabeculectomy or laser iridotomy. Preoperative IOP measured 5 mm Hg to 29 mm Hg, with eyes stratified into groups according to IOP range, Dr. Poley said. Pressures were measured preoperatively, 1 year postoperatively and at the last chart recording, from 1 to 10 years follow-up, he said.

The researchers hypothesized that the aging of the crystalline lens could be a major cause of ocular hypertension and a precursor to adult glaucoma. Dr. Poley said that pressure reductions in the glaucomatous eyes were similar to results of a study that he and his colleagues conducted of 588 nonglaucomatous subjects whose IOP was measured after phaco surgery. That study was presented at the ASCRS meeting last year.

In this year's study, Dr. Poley and colleagues found that the group of eyes with the highest pressure, ranging from 23 mm Hg to 29 mm Hg, had the highest mean reduction at 8.4 mm Hg, averaging 16.3 mm Hg at the final measurement.

The second highest pressure group had a range of 20 mm Hg to 22 mm Hg, with a reduction of 4.6 mm Hg to 16.3 mm Hg at last measurement. The group with the lowest IOP, ranging from 5 mm Hg to 14 mm Hg, had a slight elevation of 1.7 mm Hg to 13.3 mm Hg at the final measurement.

Age did not appear to affect IOP reductions, Dr. Poley said, with all age groups showing proportional pressure changes.