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Phacoemulsification reduces IOP in eyes with pseudoexfoliation

J Cataract Refract Surg. 2008;34(11):1834-1841.

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Phacoemulsification with posterior chamber IOL implantation reduced IOP and slowed the progression of glaucoma in eyes with pseudoexfoliation.

The retrospective analysis included 1,122 eyes with pseudoexfoliation that underwent phacoemulsification with IOL insertion; 882 eyes did not have glaucoma and 240 eyes had glaucoma. Research focused on IOP and changes in glaucoma medication requirements between the groups.

In the non-glaucoma group, mean IOP was reduced significantly up to 7 years postoperatively compared with before surgery. The glaucoma group had reduced mean IOP for up to 1 year and required decreasing amounts of glaucoma medication at almost all postoperative follow-up examinations.

Higher mean preop IOP and a greater reduction in mean postop IOP were correlated in both groups. IOP spikes of more than 30 mm Hg 1 day after surgery occurred in 4% of pseudoexfoliation eyes and 17% of the glaucomatous eyes.

"Many caveats attend these guidelines," the study authors said. "Surgeons must keep in mind the potential for early IOP spikes postoperatively. ... Although [non-glaucomatous] eyes rarely progressed to the need for glaucoma medication treatment in our study, many [glaucomatous] eyes still required glaucoma medicines postoperatively, albeit at a reduced level. Vigilance in monitoring for glaucoma is required in all these eyes after phacoemulsification."